Use of Oral Concomitant Medications in Patients With Acromegaly

Background: Acromegaly is a rare condition characterized by excess GH and IGF-I levels.1 Injectable somatostatin analogs (SSAs) are recommended as first-line medical treatment.2 Comorbidities including diabetes, hypertension and hypopituitarism reduce quality of life in patients with acromegaly; 3,4 treatment for these includes oral medications. We assessed the most common oral medications used by patients with acromegaly during treatment with lanreotide autogel 120 mg (LAN). Methods: This post-hoc analysis reports data from the PRIMARYS5 (NCT00690898) and LEAD6 (NCT00701363) open-label trials in which adult patients with acromegaly received LAN. PRIMARYS patients were SSA/surgery-naïve with uncontrolled acromegaly, LEAD patients were previously treated with octreotide long-acting release with normal age-adjusted IGF-I levels for two consecutive measurements. Results: PRIMARYS included 90 patients: mean (standard deviation [SD]) age 49.5 (12.4) years; 47.8% male; mean (SD) baseline IGF-I 809.9 (300.0) µg/L, 97.8% had IGF-I >1.3xULN. LEAD included 124 patients: mean (SD) age 55.4 (10.9) years; 37.1% male. Median (range) time since diagnosis was 99.0 (27.0-1,261.0) days (PRIMARYS) and 7.1 (0.5-27.0) years (LEAD). 51.1%, 24.4% and 3.3% of participants in PRIMARYS had a history of cardiovascular disorders (including hypertension), diabetes/glucose intolerance, and hypopituitarism/hypothalamic disorders; the corresponding values in LEAD were 69.4%, 33.9% and 18.5%. 83.3% of participants in PRIMARYS and 86.3% in LEAD used ≥1 concomitant oral medication with LAN. Of these participants, >50% used >3 types (PRIMARYS: 53.3%; LEAD: 61.7%). Out of participants in both studies who used concomitant oral medication with LAN, this was commonly indicated for cardiovascular disorders including: renin-angiotensin agents (PRIMARYS: 33.3%; LEAD: 45.8%); antithrombotic agents (PRIMARYS: 10.7%; LEAD: 19.6%); beta-blocking agents (PRIMARYS: 22.7%; LEAD: 19.6%) and calcium channel blockers (PRIMARYS: 16.0%; LEAD: 22.4%). Diuretics (PRIMARYS: 16.0%; LEAD: 20.6%) and lipid modifying agents (PRIMARYS: 20.0%; LEAD: 39.3%) were also common concomitant oral medications, as were medications used in diabetes (PRIMARYS: 17.3%; LEAD: 20.6%) and for thyroid therapy (PRIMARYS: 28.0%; LEAD: 31.8%). Conclusions: In this analysis, most patients with acromegaly receiving LAN, regardless of prior therapy, used ≥1 concomitant oral medication. An awareness of the ongoing burden of comorbidities requiring oral medications should help physicians in managing acromegaly. Funding: This study was sponsored by Ipsen. 1. Lavrentaki A Pituitary 2017;20:4-9 2. Melmed S Nat Rev Endocrinol. 2018;14:552-61 3. Lesén E Eur J Endocrinol. 2017:176:203-12 4. Vilar L Pituitary 2017;20:22-32 5. Caron PJ J Clin Endocrinol Metab. 2014;99:1282-90 6. Neggers SJ Eur J Endocrinol. 2015;173:313-23