Abstract
Acromegaly is a rare, chronic, and debilitating disease that results from excessive growth hormone production. Clinically, this disease is associated with enlargement of soft tissue, excessive skeletal growth, and increased risk of cardiovascular disease. Acromegaly is often diagnosed late, when a wide range of comorbidities may already be present. First-line therapy for acromegaly is typically surgery; but a number of highly-specific pharmacological agents have recently enabled a more aggressive medical management of acromegaly. Since surgical cure of acromegaly is low for macroadenomas, medical control of active acromegaly is an important component of treatment. There are no published US data currently available regarding real-world rates of comorbidities and treatment patterns among patients with acromegaly. This retrospective study examined the comorbidities and treatment patterns of 949 health plan enrollees, who had acromegaly diagnosis and/or procedure codes in an administrative claims database from July 1, 2002 through June 30, 2010. Acromegaly was associated with high rates of hypertension and diabetes along with a number of other comorbidities. The incidence of comorbidities was highest among patients with acromegaly-related treatment, which may have resulted, in part, from inadequate disease management and/or poor disease control. Unexpectedly, 55 % of patients identified with acromegaly received no treatment for acromegaly (i.e., surgery, radiotherapy, and medication) and only 28 % received a medication treatment during the observation period. However, some patients may have received a curative surgery prior to the observation period, which may have reduced the use of other acromegaly-related treatments during the study period. Of those treated with medications, the most common first medications were octreotide, cabergoline, and bromocriptine. Given the high incidence of serious comorbidities associated with active acromegaly, earlier diagnosis and treatment, along with appropriate follow-up care, may potentially avoid the life-long consequences of uncontrolled disease.
Highlights
IntroductionT. Bancroft Health Economics and Outcomes Research, OptumInsight, Eden Prairie, MN 55344, USA
The incidence of comorbidities was highest among patients with acromegaly-related treatment, which may have resulted, in part, from inadequate disease management and/or poor disease control
This study examined the real-world comorbidities and treatment of 949 acromegaly patients in two large US administrative claims databases
Summary
T. Bancroft Health Economics and Outcomes Research, OptumInsight, Eden Prairie, MN 55344, USA. M. Neary Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. Is a debilitating disorder caused by the chronic hypersecretion of growth hormone (GH). The risk of morbidity and mortality increases as the tumor size grows and GH hypersecretion continues [2, 3]. Patients often present with arrhythmias, hypertension, and valvular heart disease by the time of acromegaly diagnosis [4]. Treatments aim to reduce or control tumor growth, decrease GH levels, and normalize insulin-like growth factor 1 (IGF-1) concentrations, a hormone stimulated by GH production [5].
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