Endocrine Abstracts

Background: Medical treatment for acromegaly (characterized by excess growth hormone [GH] production) includes somatostatin receptor ligands (SRLs), dopamine agonists (DAs), and GH receptor antagonists (GHRAs). However, recent real-world United States (US) treatment evaluations are few. We present treatment patterns for patients receiving medications for acromegaly (1/1/2010–31/7/2022).

Methods: De-identified data were extracted from MarketScan^®, a US health insurance claims database. Eligible patients were ≥18-years-old at diagnosis; receiving monotherapy or combination therapy (≥2 treatments overlapping for >3 months) for ≥90 days without treatment gaps; had ≥2 claims associated with acromegaly; with data ≥3 months before and ≥6 months after diagnosis/first treatment claim (earlier date). Outcomes were: demographic characteristics; treatment frequency by line of treatment (LOT) and changes between LOTs (Sankey plot); treatment persistence for first LOT (LOT 1) monotherapies (Kaplan–Meier estimator); and treatment up-/downtitration (≥30% dose change, for octreotide long-acting release [OCT] and lanreotide depot [LAN]). Biochemical control values were unavailable.

Results: Of 882 patients, 50.1% were female; mean age at diagnosis was 48.6 years (standard deviation 13.6 years). Among patients, 59.4% had 1 LOT, 23.1% had 2 LOTs, and 17.5% had 3 LOTs. Most common LOT 1 medication class was first-generation SRLs: OCT (27.7%), LAN (21.1%). Other LOT 1 classes: DAs (cabergoline; 34.5%), GHRAs (pegvisomant; 10.5%). In LOT 1, only 7 patients received second-generation SRL pasireotide and no patients received oral octreotide. Most patients initiated treatment with monotherapies (94.6%). Among LOT 1 monotherapies, GHRAs had the longest median persistence (pegvisomant; 24.8 months; 95% confidence interval [CI]: 16.59–32.49 months; n=93), followed by first generation SRLs (OCT and LAN; 20.0 months; 95% CI: 16.98–23.87 months; n=430). DAs had the shortest persistence (cabergoline; 14.4 months; 95% CI: 12.23–16.82 months; n=304). Of patients receiving OCT or LAN, 67.6% had ≥1 dose uptitration; 45.0% had ≥1 dose downtitration.

Conclusions: Despite consensus guidelines recommending DA monotherapy for few select patients with acromegaly, our real world analysis found that approximately one third of patients initiated treatment with this class with the shortest persistence. OCT and LAN monotherapies were also commonly used as LOT 1 and had longer persistence. GHRAs, the class with the longest persistence, were not common monotherapy in LOT 1, possibly due to not targeting pituitary adenomas directly. Interestingly, only 5% of patients initiated treatment with combination therapies. Recommendations for individualized therapy should consider medication persistence and real-world treatment patterns.