Abstract
BackgroundMany patients with acromegaly require medical treatment that includes somatostatin analogs (SSAs). Long-acting SSA formulations are widely used, due in part to increased patient convenience and increased treatment adherence vs daily medications. Although medication compliance can be poor in patients with chronic conditions, adherence and persistence with these SSAs in patients with acromegaly has not been evaluated. This analysis utilized claims data to estimate treatment adherence and persistence for lanreotide depot and long-acting octreotide in this population.MethodsThis retrospective analysis used the MarketScan® database (~100 payors, 500 million claims in the US), which was searched between January 2007 and June 2012 to identify patients with acromegaly taking either lanreotide depot or long-acting octreotide. Patients switching treatments were excluded. Treatment adherence was assessed using medication possession ratio (MPR; number of doses dispensed in relation to dispensing period; ≥80% is considered adherent), injection count, and treatment time. Persistence was estimated by Kaplan-Meier analyses and Cox proportional hazards modeling. A washout period, defined as no acromegaly-related prescription activity 180 days prior to the index date, was employed to minimize effects of prior therapy and focus on patients more likely to be treatment-naïve.ResultsAltogether 1308 patients with acromegaly receiving a single SSA for treatment (1127 octreotide, 181 lanreotide) who had not switched treatments were identified. Mean MPR in patients with a 180-day washout (n = 663) was 89% for those receiving octreotide (n = 545) and 87% for those receiving lanreotide (n = 118). Median number of days on therapy was 169 (95% CI 135–232) for octreotide patients and 400 (95% CI 232–532) for lanreotide patients. The point estimate of the Cox proportional hazard ratio for stopping treatment was 1.385 for octreotide vs lanreotide (95% CI 1.079–1.777), suggesting a 38.5% increased risk for stopping octreotide before lanreotide.ConclusionsTreatment adherence was similarly good for both injectable SSA treatments studied, at 87% or greater. Persistence was greater with lanreotide than octreotide and the risk of discontinuing therapy was lower with lanreotide than octreotide. Further studies to determine factors leading to these differences in persistence or to predict discontinuation of therapy may aid in clinical management of these patients.
Highlights
Many patients with acromegaly require medical treatment that includes somatostatin analogs (SSAs)
Patients The search of the MarketScan database between January 2007 and June 2012 identified 1632 unique patients treated for acromegaly with octreotide, lanreotide, or pegvisomant, (Fig. 1)
Of these patients 1459 received a single type of therapy, and 1308 who had not switched medications received a long-acting SSA (1127 octreotide, 181 lanreotide)
Summary
Many patients with acromegaly require medical treatment that includes somatostatin analogs (SSAs). Medication compliance can be poor in patients with chronic conditions, adherence and persistence with these SSAs in patients with acromegaly has not been evaluated. This analysis utilized claims data to estimate treatment adherence and persistence for lanreotide depot and long-acting octreotide in this population. Is a disorder caused by hypersecretion of growth hormone (GH). It has an incidence of approximately 3 per million per year, a prevalence of 40–1000 per million, a mean age at diagnosis of 44 years, and an equal distribution between men and women [1,2,3]. The remission rate for resected microadenomas and macroadenomas is >85 and 40–50%, respectively, with a 5-year recurrence rate of 2–8% [6]
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