Rational pharmacotherapy of acromegaly: focus on treatment adherence

Background. Acromegaly is a syndrome that combines various histological subtypes of somatotrophic adenomas, which differ in their pathologic structure, clinical course, and sensitivity to drugs. Therefore, the effectiveness of the treatment manual depends on the timely implementation of tumor-oriented diagnostics with the clarification of the clinical, morphological and phenotypic features of somatotrophic tumors. Objective. A retrospective analysis of the results of long-term drug therapy, taking into account the selective sensitivity to somatostatin analogues of the 1st generation (SA1) among patients with acromegaly included in the Moscow registry, with the identification of possible predictors of an effective drug benefit. Methods. The paper presents the results of 545 patients (162 men, 383 woman) receiving long-term primary or secondary drug therapy SA1. Results. According to the gradient of decrease in the level of insulin-like growth factor-1 (IGF-1) after 3 months from the start of treatment, it was possible to distinguish groups of patients that differ in clinical, morphological features, the nature of receptor expression and the effectiveness of therapeutic measures. The cut-off points proposed by the authors at 3 and 12 months from the start of treatment can be used to decide whether to maintain or change the treatment tactics. A complete lack of sensitivity to SA1, detected by an evaluation test or the results of short-term treatment (3-12 months), may be a sign of the presence of a high-risk tumor that requires the use of radical methods of treatment. Conclusion. Based on the clinical picture of the disease, age-sex and morphological features, as well as the results of short-term therapeutic use of SA1, it is possible not only to predict the effectiveness of further medical treatment, but also to presumably judge the pathohistological subtype of a somatotrophic tumor. Patients ‘ adherence to treatment depends on the effectiveness of the treatment, the availability of the drug, the minimization of side effects, the tolerability and low injury rate of injections.

acromegaly, registry, somatostatin analogues, predictive and personalized treatment