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Could different treatment approaches in acromegaly influence life expectancy? A comparative study between Bulgaria and Campania (Italy).

Abstract：

BACKGROUND:Mortality in acromegaly strictly depends on optimal control of GH and IGF1 levels. Modern medical therapy with somatostatin analogs (SSAs) and GH receptor antagonists (GHRAs) is not available in many countries due to funding restrictions. This retrospective, comparative, cohort study investigated the impact of different treatment modalities on disease control (GH and IGF1) and mortality in acromegaly patients. METHODS:Two cohorts of patients with acromegaly from Bulgaria (n=407) and Campania, Italy (n=220), were compared, and mortality rates were evaluated during a 10-year period (1999-2008). RESULTS:The major difference in treatment approach between cohorts was the higher utilization of SSAs and GHRAs in Italy, leading to a decreased requirement for radiotherapy. Significantly more Italian than Bulgarian patients had achieved disease control (50.1 vs 39.1%, P=0.005) at the last follow-up. Compared with the general population, the Bulgarian cohort had a decreased life expectancy with a standardized mortality ratio (SMR) of 2.0 (95% CI 1.54-2.47) that was restored to normal in patients with disease control - SMR 1.25 (95% CI 0.68-1.81). Irradiated patients had a higher cerebrovascular mortality - SMR 7.15 (95% CI 2.92-11.37). Internal analysis revealed an independent role of age at diagnosis and last GH value on all-cause mortality and radiotherapy on cerebrovascular mortality. Normal survival rates were observed in the Italian cohort: SMR 0.66 (95% CI 0.27-1.36). CONCLUSIONS:Suboptimal biochemical control was associated with a higher mortality in the Bulgarian cohort. Modern treatment options that induce a strict biochemical control and reduce the necessity of radiotherapy might influence the life expectancy. Other factors, possibly management of comorbidities, could contribute to survival rates.

journal_name

Eur J Endocrinol

journal_title

European journal of endocrinology

authors

Colao A,Vandeva S,Pivonello R,Grasso LF,Nachev E,Auriemma RS,Kalinov K,Zacharieva S

doi

10.1530/EJE-13-1022

subject

Has Abstract

pub_date

2014-08-01 00:00:00

pages

263-73

issue

eissn

0804-4643

issn

1479-683X

pii

EJE-13-1022

journal_volume

171

pub_type

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Could different treatment approaches in acromegaly influence life expectancy? A comparative study between Bulgaria and Campania (Italy).