First-generation somatostatin receptor ligands in the treatment of acromegaly: real-world patient journey
T. Brue*a (Dr), A. Barkanb (Dr), A. Ribeiro-Oliveira Jrc (Dr), M. Del Pilar Schneiderd (Dr), Y. Darhie (Mr), M. Fleseriuf (Dr), S. Melmedg (Dr)
a Aix-Marseille University, Marseille, FRANCE ; b University of Michigan, Ann Arbor, UNITED STATES ; c Ipsen, Cambridge, UNITED STATES ; d Ipsen, Les Ulis, FRANCE ; e Ipsen, Boulogne-Billancourt, FRANCE ; f Oregon Health and Science University, Portland, UNITED STATES ; g University of California, Los Angeles, Los Angeles, UNITED STATES
Investigate the treatment journey of patients receiving medications for acromegaly.
Material and methods
Somatostatin receptor ligands (SRLs), dopamine agonists (DAs) and growth hormone receptor antagonists (GHRAs) are recommended to treat acromegaly. Real-world studies evaluating treatment patterns with these medication classes are limited.
De-identified patient data were extracted from MarketScan®, a US claims database (01/01/2010-05/31/2020). Eligible patients received monotherapy or combination therapy (≥2 treatments overlapping for >3 months) for ≥90 days.
Overall, outcomes included the proportion of patients receiving a line of therapy (LOT) in each year and changes in LOT throughout the treatment period.
For patients receiving monotherapy without >3 month prescription gaps, outcomes included the proportion receiving each medication class, treatment adherence (medication possession ratio [MPR] >0.80, days of medication supply divided by days in LOT) and treatment persistence (time from first treatment record to change in LOT or censoring [Kaplan-Meier estimates]).
The most common medication class observed was first-generation SRLs (i.e., lanreotide or octreotide; n=381), followed by DAs (n=241), GHRAs (n=109) and second-generation SRLs (i.e., pasireotide; n=11). The proportion on each therapy remained stable throughout the study period.
Most patients (80.8%) did not switch treatments. Of the 48.3% and 34.0% of patients initiating treatment with first‑generation SRLs or DAs, 78.7% and 86.3%, respectively, never switched therapies (although several treatment gaps were observed with DAs). Few patients (5.8%) initiated combination therapy.
Treatment adherence did not differ significantly between any medication classes. Median persistence with first-generation SRLs (1,343 days) or GHRAs (2,284 days) was significantly higher than with DAs (581 days). Biochemical control values were not available for any included patients.
SRLs are recommended first-line therapy for moderate-to-severe acromegaly;1 nevertheless, many patients initiated treatment with DAs. Although this observation may suggest many patients presented with mild disease, persistence was also lowest for DAs, highlighting the importance for physicians to consider current treatment guidelines/recommendations. Interestingly, most patients did not switch medications after treatment initiation, indicating a degree of inertia in acromegaly treatment choices; patients may therefore achieve the best long‑term outcomes by initiating medications with greater persistence records.
- Acromegaly. NHS. 2020.
The author has declared the following conflict(s) of interest:
Thierry Brue received funding and medical writing support from Ipsen; received consulting fees from Ipsen, Recordati, Novartis and Pfizer; received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Recordati, Novartis and Ipsen; received support for attending meetings and/or travel from Ipsen and Pfizer; participated on a Data Safety Monitoring Board or Advisory Board for Advanz Pharma and Recordati; and received a grant to Aix-Marseille University from Pfizer.
Ariel Barkan has no conflicts of interest to disclose.
Antonio Ribeiro-Oliveira Jr is an employee of Ipsen and holds stock in Ipsen.
Maria del Pilar Schneider is an employee of Ipsen.
Yannis Darhi is an employee of Ipsen.
Maria Fleseriu received a research grant to Oregon Health and Science University as principal investigator for Amryt, Crinetics, Ionis, and Recordati and served as an occasional scientific consultant or advisory board member for Amryt, Crinetics, Ionis, Ipsen, Pfizer and Recordati.
Shlomo Melmed received consulting fees from Novo Nordisk, Recordati Rare Diseases and Ionis; received an educational grant from Ipsen; serves as the secretary for the Pituitary Society; and received a grant to the University of California, Los Angeles from Pfizer.