title: Changes in acromegaly treatment over four decades in Spain: analysis of the Spanish Acromegaly Registry (REA).
abstract: Since 1997 there is an online National Registry of acromegalic patients in Spain (REA). We aimed to study changes in acromegaly treatment and outcomes over the last four decades in Spain. In REA clinical and biochemical data are collected at diagnosis and updated every one to 2 years. We analyzed the first treatment received and the different treatments administered according to decade of diagnosis of acromegaly: prior to 1980, 1980-1989, 1990-1999 and 2000-2009. Surgical cure rates according to pretreatment with long-acting somatostatin receptor ligands (SRLs) were also analyzed. 1,658 patients were included of which 698 had accurate follow-up data. Treatment of acromegaly changed over time. Surgery was the main treatment option (83.8 %) and medical treatment was widely used (74.7 %) both maintained over decades, while radiation therapy declined (62.8, 61.6, 42.2 and 11.9 % over decades, p < 0.001). First treatment type also changed: surgery was the first line option up until the last decade in which medical treatment was preferred (p < 0.001). Radiotherapy was barely used as first treatment. Treatment combinations changed over time (p < 0.001). The most common treatment combination (surgery plus medical therapy), was received by 24.4, 16.4, 25.3 and 56.5 % of patients over decades. Medical treatment alone was performed in 7.3, 6, 7.2 and 14.7 % over decades. Type of medical treatment also changed, SRLs becoming the first medical treatment modality in the last decades, whereas dopamine agonist use declined (p < 0.001). Surgical cure rates improved over decades (21, 21, 36 and 38 %, p = 0.002) and were not influenced by SRL pre-surgical use. Acromegaly treatment has changed in Spain in the last four decades. Surgery has been the main treatment option for decades; however, medical therapy has replaced surgery as first line in the last decade and radiotherapy rates have clearly declined. SRLs are the most used medical treatment.
authors.affiliation: Servicio de Endocrinología, Institut Universitari Dexeus, C/Sabino de Arana 5-19, 08028, Barcelona, Spain. 30064gsl@comb.cat
authors.forename: Gemma
authors.initials: G
authors.lastname: Sesmilo
authors.forename: Sonia
authors.initials: S
authors.lastname: Gaztambide
authors.forename: Eva
authors.initials: E
authors.lastname: Venegas
authors.forename: Antonio
authors.initials: A
authors.lastname: Picó
authors.forename: Carlos
authors.initials: C
authors.lastname: Del Pozo
authors.forename: Concepción
authors.initials: C
authors.lastname: Blanco
authors.forename: Elena
authors.initials: E
authors.lastname: Torres
authors.forename: Cristina
authors.initials: C
authors.lastname: Álvarez-Escolà
authors.forename: Carmen
authors.initials: C
authors.lastname: Fajardo
authors.forename: Rogelio
authors.initials: R
authors.lastname: García
authors.forename: Rosa
authors.initials: R
authors.lastname: Cámara
authors.forename: Ignacio
authors.initials: I
authors.lastname: Bernabeu
authors.forename: Alfonso
authors.initials: A
authors.lastname: Soto
authors.forename: Carles
authors.initials: C
authors.lastname: Villabona
authors.forename: Alicia
authors.initials: A
authors.lastname: Serraclara
authors.forename: Irene
authors.initials: I
authors.lastname: Halperin
authors.forename: Victoria
authors.initials: V
authors.lastname: Alcázar
authors.forename: Elisabet
authors.initials: E
authors.lastname: Palomera
authors.forename: Susan M
authors.initials: SM
authors.lastname: Webb
mesh_terms: D000172:Acromegaly / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery*; D000328:Adult; D005260:Female; D019382:Human Growth Hormone / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D000091402:Prohibitins; D012042:Registries; D012984:Software; D013030:Spain
chemical_list: C000717331:PHB2 protein, human; D000091402:Prohibitins; D019382:Human Growth Hormone