ACROSTART: A retrospective study of the time to achieve hormonal control with lanreotide Autogel treatment in Spanish patients with acromegaly / ACROSTART: Estudio retrospectivo del período de tiempo para lograr el control hormonal con lanreótida Autogel en pacientes con acromegalia en la práctica clínica española

Objectives: The ACROSTART study was intended to determine the time to achieve normalization of GH and IGF-I levels in responding patients with acromegaly administered different dosage regimens of lanreotide Autogel (Somatuline(R) Autogel(R)). Methods: From March 2013 to October 2013, clinical data from 57 patients from 17 Spanish hospitals with active acromegaly treated with lanreotide for ≥4 months who achieved hormonal control (GH levels <2.5ng/ml and/or normalized IGF-I levels in ≥2 measurements) were analyzed. The primary objective was to determine the time from start of lanreotide treatment to hormonal normalization. Results: Median patient age was 64 years, 21 patients were male, 39 patients had undergone surgery, and 14 patients had received radiotherapy. Median hormonal values at start of lanreotide treatment were: GH, 2.6ng/ml; IGF-I, 1.6×ULN. The most common starting dose of lanreotide was 120mg (29 patients). The main initial regimens were 60mg/4 weeks (n=13), 90mg/4 weeks (n=6), 120mg/4 weeks (n=13), 120mg/6 weeks (n=6), and 120mg/8 weeks (n=9). An initial treatment regimen with a long interval (≥6 weeks) was administered in 25 patients. Mean duration of lanreotide treatment was 68 months (7-205). Median time to achieve hormonal control was 4.9 months. Injections were managed without healthcare assistance in 13 patients. Median number of visits to endocrinologists until hormonal control was achieved was 3. Fifty-one patients were "satisfied"/"very satisfied" with treatment and 49 patients did not miss any dose. Conclusions: Real-life treatment with lanreotide Autogel resulted in early hormonal control in responding patients, with high treatment adherence and satisfaction despite disparity in starting doses and dosing intervals

Objetivos: El objetivo del estudio ACROSTART era determinar el período de tiempo para lograr la normalización hormonal (GH e IGF-I) en pacientes con acromegalia respondedores al tratamiento considerando los regímenes de lanreótida Autogel (Somatuline(R) Autogel(R)) utilizados en la práctica clínica. Métodos: Desde marzo de 2013 hasta octubre de 2013, en 17 hospitales españoles se analizaron los datos clínicos de 57 pacientes con acromegalia activa tratados con lanreótida durante ≥4 meses que lograron control hormonal (niveles de GH <2,5ng/ml y/o IGF-I normalizado en ≥2 evaluaciones). El objetivo principal fue determinar el período de tiempo desde el inicio del tratamiento con lanreótida hasta la normalización hormonal. Resultados: La mediana de edad de los pacientes fue 64 años, 21 pacientes eran hombres, 39 pacientes habían recibido cirugía, 14 pacientes habían recibido radioterapia. Los valores hormonales medianos al inicio del tratamiento con lanreótida fueron GH: 2,6ng/ml, IGF-I: 1,6×LSN. La dosis inicial más frecuente de lanreótida fue de 120mg (29 pacientes). Los principales regímenes iniciales fueron 60mg/4 semanas (n=13), 90mg/4 semanas (n=6), 120mg/4 semanas (n=13), 120mg/6 semanas (n=6), 120mg/8 semanas (n=9). Se administró un régimen de intervalo prolongado (≥6 semanas) en 25 pacientes. La duración media del tratamiento con lanreótida fue de 68 meses (7-205). El tiempo medio hasta lograr el control hormonal fue de 4,9 meses. Las inyecciones se manejaron sin asistencia médica en 13 pacientes. La mediana del número de visitas al endocrinólogo hasta el control hormonal fue 3. Cincuenta y un pacientes estaban "satisfechos"/"muy satisfechos" con el tratamiento y 49 pacientes no olvidaron ninguna dosis. Conclusiones: El tratamiento en la vida real con lanreótida Autogel condujo a un control hormonal temprano en pacientes que respondieron, con una alta adherencia al tratamiento y satisfacción con el tratamiento, a pesar de la disparidad de las dosis iniciales y los intervalos de dosificación

ACROSTART: A retrospective study of the time to achieve hormonal control with lanreotide Autogel treatment in Spanish patients with acromegaly.

OBJECTIVES: The ACROSTART study was intended to determine the time to achieve normalization of GH and IGF-I levels in responding patients with acromegaly administered different dosage regimens of lanreotide Autogel (Somatuline® Autogel®). METHODS: From March 2013 to October 2013, clinical data from 57 patients from 17 Spanish hospitals with active acromegaly treated with lanreotide for ≥4 months who achieved hormonal control (GH levels <2.5ng/ml and/or normalized IGF-I levels in ≥2 measurements) were analyzed. The primary objective was to determine the time from start of lanreotide treatment to hormonal normalization. RESULTS: Median patient age was 64 years, 21 patients were male, 39 patients had undergone surgery, and 14 patients had received radiotherapy. Median hormonal values at start of lanreotide treatment were: GH, 2.6ng/ml; IGF-I, 1.6×ULN. The most common starting dose of lanreotide was 120mg (29 patients). The main initial regimens were 60mg/4 weeks (n=13), 90mg/4 weeks (n=6), 120mg/4 weeks (n=13), 120mg/6 weeks (n=6), and 120mg/8 weeks (n=9). An initial treatment regimen with a long interval (≥6 weeks) was administered in 25 patients. Mean duration of lanreotide treatment was 68 months (7-205). Median time to achieve hormonal control was 4.9 months. Injections were managed without healthcare assistance in 13 patients. Median number of visits to endocrinologists until hormonal control was achieved was 3. Fifty-one patients were "satisfied"/"very satisfied" with treatment and 49 patients did not miss any dose. CONCLUSIONS: Real-life treatment with lanreotide Autogel resulted in early hormonal control in responding patients, with high treatment adherence and satisfaction despite disparity in starting doses and dosing intervals.

Tratamiento con radioyodo en el hipertiroidismo: resultados a largo plazo / Radioiodine in hyperthyroidism: long-term outcomes

Introducción: El 131I es una opción terapéutica eficaz para el tratamiento del hipertiroidismo, aunque en un alto porcentaje de pacientes se desarrolla hipotiroidismo definitivo. Objetivo: Evaluar la función tiroidea a largo plazo de pacientes con hipertiroidismo tras el tratamiento con 131I. Pacientes y método: Se estudió retrospectivamente a 128 pacientes hipertiroideos que recibieron 131I entre 1994 y 1999. Se excluyó a 32 por pérdida en el seguimiento y se clasificó a los 96 sujetos incluidos, según la afección tiroidea, en GB (Graves-Basedow, n = 46), BMN (bocio multinodular, n = 35) y AT (adenoma tóxico, n = 15). El tiempo de seguimiento fue 7,3 ± 0,2 años y la dosis media de 131I, 12,2 ± 0,3 mCi. Resultados: De los 96 pacientes, en el 58,3% se desarrolló hipotiroidismo, el 34,4% mantenía normofunción tiroidea y el 7,3% restante permanecía con hiperfunción clínica o subclínica. El 19,8% (n = 19) precisó más de una dosis de 131I. En el grupo GB, el 87% evolucionó a hipotiroidismo, el 10,9% persistía eutiroideo y el 2,1%, con hiperfunción; recibieron 2 dosis de 131I 10 (21,7%) pacientes. Del grupo BMN, el 28,6% quedó hipotiroideo; el 54,3%, eutiroideo y el 17,1%, con hiperfunción; 7 (20%) pacientes necesitaron 2 dosis y 2 (5,7%) pacientes, 3 dosis. En el grupo AT, el 40% desarrolló hipotiroidismo y el 60% mantenía normofunción tiroidea; 2 (13,3%) pacientes recibieron 2 dosis. Conclusiones: La tasa de hipotiroidismo definitivo en el grupo GB es superior a la de los otros 2 grupos. El alto porcentaje de pacientes con BMN que persisten hipertiroideos tras 131I indica que son necesarias dosis superiores en este grupo

Background: Radioiodine treatment is a safe and effective therapeutic option for hyperthyroidism, although the incidence of subsequent definitive hypothyroidism is high. Objective: To evaluate long-term thyroid function after radioiodine treatment in hyperthyroid patients. Patients and method: We performed a retrospective study of 128 hyperthyroid patients administered 131I between 1994 and 1999. We excluded 32 patients who were lost to follow-up. The 96 patients included were categorized into Graves' disease (GD), n = 46, toxic multinodular goiter (TMG), n = 35, and toxic adenoma (TA), n = 15. The mean time of follow-up was 7.3 ± 0.2 years and the mean 131I dose was 12.2 ± 0.3 mCi. Results: Among the 96 patients, hypothyroidism developed in 58.3%, normal thyroid function was achieved in 34.4% and some degree of hyperthyroidism persisted in 7.3%. More than one radioiodine dose was required in 19.8% (n = 19). In GD patients, hypothyroidism appeared in 87%, euthyroidism was achieved in 10.9%, and hyperthyroidism persisted in 2.1%. Ten patients required second 131I doses. In the TMG group, hypothyroidism developed in 28.6%, euthyroidism was achieved in 54.3% and hyperthyroidism was present in 17.1%. Seven patients (20%) were administered a second radioiodine dose and two patients (5.7%) received a third dose. In the TA group, hypothyroidism developed in 40% and euthyroidism was achieved in 60%. Two patients (13.3%) received a second 131I dose. Conclusions: The incidence of definitive hypothyroidism was higher in the GD group than in the TMG and TA groups. The high percentage of TMG patients with persistent hyperthyroidism suggests the need for higher radioiodine doses in this group