Predictors of the effectiveness of drug therapy of acromegaly (according to the Moscow register)

Background. Acromegaly is a chronic multiorgan disease that adversely affects the quality and life expectancy of the patient. Created in 2003, the Moscow register of patients with acromegaly and pituitary gigantism serves as an example of a multidisciplinary approach to solving the problem of managing rare diseases with the organization of a modern diagnostic and treatment base, the continuity of treatment, and effective drug provision. Despite the successes achieved in the treatment of acromegaly, however, the problem of adequate medication remains due to the presence of multiple pathomorphological variants of GH-secreting tumors that affect drug sensitivity. Objective. Analysis of the results of long-term primary and secondary drug therapy (DT) with the identification of possible predictors of effective treatment. Methods. The data of 484 patients (139 men, 345 women) who received multiannual primary or secondary DT with first-generation somatostatin analogues (SA1) are presented. The dopamine agonist cabergoline was used in cases of low secretory activity of the disease, the presence of mixed (GH- and prolactin-secreting tumors), as well as in the detection of relative resistance to SA1. Results. When conducting primary and secondary DT, sensitivity to AC1, assessed by the gradient of a decrease in the insulin-like growth factor-1 level after 3 and 12 months of treatment, is considered a predictive predictor of successful medical benefits. It is assumed that these cut-off points can be used to address the issue of maintaining or changing treatment tactics. Conclusion. Further improvement of knowledge about biomarkers characterizing the status and state of GH-secreting adenomas opens up prospects for predicting tumor development scenarios and for providing differentiated therapeutic benefits for acromegaly syndrome.

acromegaly, register, somatostatin analogues, predictive and personalized treatment