Multivariable Prediction Model for Biochemical Response to First-Generation Somatostatin Receptor Ligands in Acromegaly.
J Clin Endocrinol Metab
; 105(9)2020 09 01.
Article
en En
| MEDLINE
| ID: mdl-32589751
ABSTRACT
CONTEXT First-generation somatostatin receptor ligands (fg-SRLs) represent the mainstay of medical therapy for acromegaly, but they provide biochemical control of disease in only a subset of patients. Various pretreatment biomarkers might affect biochemical response to fg-SRLs. OBJECTIVE:
To identify clinical predictors of the biochemical response to fg-SRLs monotherapy defined as biochemical response (insulin-like growth factor (IGF)-1â ≤â 1.3â ×â ULN (upper limit of normal)), partial response (>20% relative IGF-1 reduction without normalization), and nonresponse (≤20% relative IGF-1 reduction), and IGF-1 reduction.DESIGN:
Retrospective multicenter study.SETTING:
Eight participating European centers.METHODS:
We performed a meta-analysis of participant data from 2 cohorts (Rotterdam and Liège acromegaly survey, 622 out of 3520 patients). Multivariable regression models were used to identify predictors of biochemical response to fg-SRL monotherapy.RESULTS:
Lower IGF-1 concentration at baseline (odds ratio (OR)â =â 0.82, 95% confidence interval (CI) 0.72-0.95 IGF-1 ULN, Pâ =â .0073) and lower bodyweight (ORâ =â 0.99, 95% CI 0.98-0.99 kg, Pâ =â .038) were associated with biochemical response. Higher IGF-1 concentration at baseline (ORâ =â 1.40, (1.19-1.65) IGF-1 ULN, Pâ ≤â .0001), the presence of type 2 diabetes (oral medication ORâ =â 2.48, (1.43-4.29), Pâ =â .0013; insulin therapy ORâ =â 2.65, (1.02-6.70), Pâ =â .045), and higher bodyweight (ORâ =â 1.02, (1.01-1.04) kg, Pâ =â .0023) were associated with achieving partial response. Younger patients at diagnosis are more likely to achieve nonresponse (ORâ =â 0.96, (0.94-0.99) year, Pâ =â .0070). Baseline IGF-1 and growth hormone concentration at diagnosis were associated with absolute IGF-1 reduction (ßâ =â 0.90, standard error (SE)â =â 0.02, Pâ ≤â .0001 and ß â =â 0.002, SEâ =â 0.001, Pâ =â .014, respectively).CONCLUSION:
Baseline IGF-1 concentration was the best predictor of biochemical response to fg-SRL, followed by bodyweight, while younger patients were more likely to achieve nonresponse.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Acromegalia
/
Somatostatina
/
Receptores de Somatostatina
/
Biomarcadores Farmacológicos
/
Modelos Teóricos
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Systematic_reviews
Límite:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
País/Región como asunto:
Europa
Idioma:
En
Revista:
J Clin Endocrinol Metab
Año:
2020
Tipo del documento:
Article
País de afiliación:
Países Bajos