Control of growth hormone and IGF1 in patients with acromegaly in the UK: responses to medical treatment with somatostatin analogues and dopamine agonists
Control of growth hormone and IGF1 in patients with acromegaly in the UK: responses to medical treatment with somatostatin analogues and dopamine agonists
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DOI：
10.1111/cen.12207
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发表时间：
2013-11-01
影响因子：
3.2
通讯作者：
Trainer, Peter J.
中科院分区：
文献类型：
--
作者：
Howlett, Trevor A.;Willis, Debbie;Trainer, Peter J.
我们调查了在英国常规临床实践中控制肢端肥大症患者的GH和IGF1的药物治疗和非药物治疗。设计英国肢端肥大症登记处收集了来自31个英国中心的肢端肥大症患者的常规生化和临床数据，GH数据覆盖> 30年。406%的患者使用生长抑素类似物（SMS），414%的患者使用多巴胺受体激动剂（DA）。测量我们确定了29，181条GH记录与IGF 1、手术、放疗和药物治疗相关的数据，并获得了9900个不同护理期的数据，包括4206个药物治疗疗程。我们认为GH控制时，2g/l.ResultsGH和IGF 1的控制随着时间的推移，特别是在药物治疗。在既往手术和/或放疗后，药物治疗的控制更好。在长期SMS中，GH控制在75%，IGF 1控制在69%，两者都控制在55%;在长期DA中，GH控制相似，但IGF 1较差（77%/55%/45%）。奥曲肽LAR和兰瑞肽autogel长期治疗的反应大致相似，但我们注意到未能将SMS递增至最大有效剂量。增加precourse生长激素水平与下降的比例谁达到控制，尽管从baseline. ConclusionsControl肢端肥大症在英国正在改善，但安全的GH水平仍然只有75%的长期药物治疗，与GH和IGF 1都正常化不超过55%的SMS和36%卡麦角林。目前尚不清楚在许多患者中观察到的GH而不是IGF 1的控制是否足以使长期发病率和死亡率恢复正常。
ObjectiveWe investigated the control of GH and IGF1 in acromegaly in routine clinical practice in the UK on and off medical treatment.DesignThe UK Acromegaly Register collected routine biochemical and clinical data on patients with acromegaly from 31 UK centres with GH data covering >30y.PatientsWe identified 2572 patients. Somatostatin analogues (SMS) were used in 406% and dopamine agonists (DA) in 414%.MeasurementsWe identified 29,181 GH records linked to data on IGF1, surgery, radiotherapy and medical treatment and derived data on 9900 distinct Periods of Care including 4206 courses of medical treatment. We considered GH controlled when 2g/l.ResultsControl of GH and IGF1 improved over time, particularly on medical treatment. Control on medical treatment was better after prior surgery and/or radiotherapy. On long-term SMS, GH was controlled in 75%, IGF1 in 69% and both in 55%; on long-term DA, GH control was similar but IGF1 worse (77%/55%/45%). Responses to long-term treatment with octreotide LAR and lanreotide autogel were broadly similar, but we noted a failure to escalate SMS to maximal effective dose. Increasing precourse GH levels were associated with a decreasing proportion who achieved control, despite greater suppression from baseline.ConclusionsControl of acromegaly in the UK is improving, but safe' GH levels are still only achieved in 75% on long-term medical treatment, with GH and IGF1 both normalized in no more than 55% on SMS and 36% on cabergoline. It remains unclear whether the control of GH, but not IGF1, observed in many patients is sufficient to restore long-term morbidity and mortality to normal.