Trends in acromegaly treatment in Spain
Gemma Sesmilo1, Sonia Gaztambide2, Antonio Picó3, Alfonso Soto4, Elena Torres5, Carmen Fajardo6, Concepción Blanco7 & Susan Webb8Onbehalf of REA investigators1
The Spanish acromegaly registry (REA) is an online epidemiological database created in 1997 to collect clinical and biochemical data of patients with acromegaly followed in Spain.
Aim: To study trends in acromegaly treatment over time in Spain.
Methods: REA is an online database in which registered endocrinologists collect data from all acromegalic patients seen at their practices in Spain. In the last year the neuroendocrine group of the Spanish Society of Endocrinology and Nutrition (SEEN) urged investigators for new data entry, and updating of previous patients. Variables collected included: demographics, estimated date of symptoms, date of diagnosis, pituitary imaging (tumor size and tumor extension), tumor persistence after surgery, visual fields, baseline GH, GH after an oral glucose tolerance test (OGTT) and IGF1 concentrations. GH and IGF1 measurements were performed in each center, and IGF1- reported as normal or abnormally high or low, according to local reference values, was also recorded. Date of diagnosis and co-morbidities were included as well as medical, surgical and radiation treatments and dates when received. All clinical variables were collected at diagnosis and at yearly biyearly intervals. For all treatments date of start and end was collected. Descriptive statistics were used to analyse data only in updated patients.
Results: As of 31 of December 2009, 1570 patients with acromegaly were included in the database of whom 620 have complete data follow-up and were suitable for analysis. There was 62.5 women and 37.5% men. Sixty-seven percent of patients had a macroadenoma and 33% had microadenomas. Ninety-two percent of patients had surgery whereas 35% had radiation therapy. Eighty nine % of patients received medical treatment for acromegaly. When analyzing type of treatments performed by decades, we observed a trend towards less use of radiation therapy (19, 85, 87, 21 treatments for decades 7079, 8089, 902000 and 20002010 respectively for a total of 67, 299, 411 and 329 treatments each decade), surgical rates have been maintained over time (21, 117, 177, 159 for the same number of total treatments by decade), and use of medical therapy has increased (27, 97, 147, 149).
Conclusion: Treatment of acromegaly in Spain has changed over time. Surgery is still the mainstay of treatment and use of medical therapy has increased whereas radiation treatment rates have decreased.