Effects of growth hormone receptor antagonism and somatostatin analog administration on quality of life in acromegaly.

Abstract

Acromegaly is associated with impaired quality of life (QoL). We investigated the effects of biochemical control of acromegaly by growth hormone receptor antagonism vs somatostatin analog therapy on QoL. Cross-sectional. 116 subjects: n=55 receiving a somatostatin analog (SSA group); n=29 receiving pegvisomant (PEG group); n=32 active acromegaly on no medical therapy (ACTIVE group). Acromegaly QoL Questionnaire (AcroQoL), Rand 36-Item Short Form Survey (SF-36) and Gastrointestinal QoL Index (GIQLI); fasting glucose, insulin and IGF-1 levels (LC/MS, Quest Diagnostics). There were no group differences in mean age, BMI or sex [(whole cohort mean ± SD) age 52±14years, BMI 30±6kg/m2 , and male sex 38%]. Mean IGF-1 Z-scores were higher in ACTIVE (3.9±1.0) vs SSA and PEG, which did not differ from one another (0.5±0.7 and 0.5±0.7, P<.0001 vs ACTIVE). Eighty-three per cent of PEG previously received somatostatin analogs, which had been discontinued due to lack of efficacy (52%) or side effects (41%). There were no differences in the four QoL primary end-points (AcroQoL Global Score, SF-36 Physical Component Summary Score, SF-36 Mental Health Summary Score and GIQLI Global Score) between SSA and PEG. Higher HbA1c, BMI and IGF-1 Z-scores were associated with poorer QoL in several domains. Our data support a comparable QoL in patients receiving pegvisomant vs somatostatin analogs, despite the fact that the vast majority receiving pegvisomant did not respond to or were not able to tolerate somatostatin analogs.