Medical Treatments for Acromegaly: A Systematic Review and Network Meta-Analysis

• Type: Another Publication in an International Scientific Journal
• Date: 2018

Authors

Leonart, LP (Author) Other; Ferreira, VL (Author) Other; Tonin, FS (Author) Other; Fernandez Llimos, F (Author) Other; Pontarolo, R (Author) Other

Journal

Title: Value in Health

Vol. 21

Pages: 874-880

ISSN: 1098-3015

Publisher: Elsevier

Indexing

ISI Web of Knowledge - 10 Citations

Scopus - 13 Citations

Other information

Authenticus ID: P-00N-V1X

DOI: 10.1016/j.jval.2017.12.014

Abstract (EN): Background: Acromegaly results from the hypersecretion of growth hormone. Because of the low incidence rates of this disease worldwide, few clinical trials evaluating drug treatments have been conducted. Objectives: To conduct the first network meta-analysis simultaneously comparing all available drugs used in acromegaly treatment so as to provide more robust evidence in this field. Methods: A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane Collaboration recommendations (PROSPERO database under the registration number CRD42017059880). The electronic searches were conducted in PubMed (MEDLINE), Scopus, and Web of Science databases. Randomized controlled trials comparing any drug for the treatment of acromegaly head-to-head or versus placebo were included. Outcomes concerning the efficacy and safety of treatments were evaluated. The statistical analyses were performed using Aggregate Data Drug Information System version 1.16.8 (drugis.org, Groningen, The Netherlands). Results: The initial search retrieved 2059 articles. Of these, 10 randomized controlled trials were included in a qualitative analysis and 7 in a quantitative analysis. The network meta-analysis for the efficacy outcome (number of patients achieving insulinlike growth factor 1 control) showed that pegvisomant and lanreotide autogel were statistically superior to placebo (odds ratio [95% credible interval] 0.06 [0.00-0.55] and 0.09 [0.01-0.88]). No further differences were found. The probability rank indicated that pegvisomant and pasireotide have the highest probabilities (33% and 34%, respectively) of being the best therapeutic options. No major side effects were noted. Conclusions: Pegvisomant is still a good option for acromegaly treatment, but pasireotide seems to be a promising alternative. Nevertheless, other important key factors such as drug costs and effectiveness (real-world results) should be taken into account when selecting acromegaly treatment.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 7