Effectiveness of combined first-line medical treatment in acromegaly with prolactin cosecretion
Betina Biagetti, Marta Araujo‐Castro, Edelmiro Menéndez Torre, Iría Novoa-Testa, Fernando Cordido, Eider Pascual‐Corrales, Víctor Rodríguez Berrocal, Fernando Guerrero‐Pérez, Almudena Vicente, Juan Carlos Percovich, Rogelio García Centeno, Laura González Fernández, María Dolores Ollero García, Ana Irigaray, María Dolores Moure Rodríguez, Cristina Novo‐Rodríguez, María Calatayud, Rocío Villar‐Taibo, Ignacio Bernabéu, Cristina Álvarez-Escolá, Pamela Benítez Valderrama, Carmen Tenorio-Jiménez, Pablo Abellán Galiana, Eva Venegas Moreno, Inmaculada González Molero, Pedro Iglesias, Concepción Blanco, Fernando Vidal-Ostos De Lara, Paz de Miguel, Elena López Mezquita, Felicia A. Hanzu, Ibán Aldecoa, Silvia Aznar, Cristina Lamas, Anna Aulinas, Queralt Asla, Paola Gracia, José María Recio Córdova, Mariola Aviles, Diego Asensio-Wandosel, Miguel Sampedro, Rosa Cámara, Miguel Paja, Ignacio Ruz‐Caracuel, Carmen Fajardo, Esteban Cordero Asanza, Elena Martínez‐Sáez, Mónica Marazuela, Manel Puig‐Domingo
Abstract
OBJECTIVE: The aim of this study is to compare the response to first-line medical treatment in treatment-naive acromegaly patients with pure growth hormone (GH)-secreting pituitary adenoma (GH-PA) and those with GH and prolactin cosecreting PA (GH&PRL-PA). DESIGN: This is a retrospective multicentric study of acromegaly patients followed from 2003 to 2023 in 33 tertiary Spanish hospitals with at least 6 months of first-line medical treatment. METHODS: Baseline characteristics, first-line medical treatment strategies, and outcomes were analyzed. We employed a multiple logistic regression full model to estimate the impact of some baseline characteristics on disease control after each treatment modality. RESULTS: Of the 144 patients included, 72.9% had a GH-PA, and 27.1% had a GH&PRL-PA. Patients with GH&PRL-PA were younger (43.9 ± 15.0 vs 51.9 ± 12.7 years, P < .01) and harboring more frequently macroadenomas (89.7% vs 72.1%, P = .03). First-generation somatostatin receptor ligand (fgSRL) as monotherapy was given to 106 (73.6%) and a combination treatment with fgSRL and cabergoline in the remaining 38 (26.4%). Patients with GH&PRL-PA received more frequently a combination therapy (56.4% vs 15.2%, P < .01). After 6 months of treatment, in the group of patients under fgSRL as monotherapy, those patients with GH&PRL-PA had worse control compared to GH-PAs (29.4% vs 55.1%, P = .04). However, these differences in the rate of disease control between both groups disappeared when both received combination treatment with fgSRL and cabergoline. CONCLUSION: In GH&PRL-PA, the biochemical control achieved with fgSRL as monotherapy is substantially worse than in patients harboring GH-PA, supporting the inclusion of cabergoline as first-line medical treatment in combination with fgSRLs in these subgroups of patients.