title: Surgical interventions and medical treatments in treatment-naïve patients with acromegaly: systematic review and meta-analysis.
abstract: BACKGROUND
  Acromegaly is usually treated with surgery as a first-line treatment, although medical therapy has also been used as an alternative primary treatment.
  
  
  OBJECTIVE
  We conducted a systematic review and meta-analysis to synthesize the existing evidence comparing these two approaches in treatment-naïve patients with acromegaly.
  
  
  METHODS
  This study performed a comprehensive search in multiple databases, including Medline, EMBASE, and Scopus from early inception through April 2014.
  
  
  METHODS
  The study used original controlled and uncontrolled studies that enrolled patients with acromegaly to receive either surgical treatment or medical treatment as their first-line treatment.
  
  
  METHODS
  Reviewers extracted data independently and in duplicates. Because of the noncomparative nature of the available studies, we modified the Newcastle-Ottawa Scale to assess the quality of included studies. Outcomes evaluated were biochemical remission and change in IGF-1 or GH levels. We pooled outcomes using the random-effects model.
  
  
  RESULTS
  The final search yielded 35 studies enrolling 2629 patients. Studies were noncomparative series with a follow-up range of 6-360 months. Compared with medical therapy, surgery was associated with a higher remission rate (67% vs 45%; P = .02). Surgery had higher remission rates at longer follow-up periods (≥ 24 mo) (66% vs 44%; P = .04) but not the shorter follow-up periods (≤ 6 mo) (37% vs 26%; P = .22) [Corrected].Surgery had higher remission rates in the follow-up levels of GH (65% vs 46%; P = .05). In one study, the IGF-1 level was reduced more with surgery compared with medical treatment (-731 μg/L vs -251 μg/L; P = .04). Studies in which surgery was performed by a single operator reported a higher remission rate than those with multiple operators (71% vs 47%; P = .002).
  
  
  CONCLUSIONS
  Surgery may be associated with higher remission rate; however, the confidence in such evidence is very low due to the noncomparative nature of the studies, high heterogeneity, and imprecision.
authors.affiliation: Division of Preventive, Occupational, and Aerospace Medicine (A.M.A.D., M.H.M.), Mayo Clinic, Rochester Minnesota 55905, Knowledge and Evaluation Research Unit (A.M.A.D., K.M., N.A., W.H.F., Z.W., M.H.F., M.H.M.), Center for the Science of Health Care Delivery, Mayo Clinic, Rochester Minnesota 55905, Library Public Services (L.J.P.), Mayo Clinic, Rochester Minnesota 55905, and Department of Medicine, Division of Endocrinology and Metabolism and Department of Neurosurgery (L.K.), Stanford University School of Medicine, Stanford, California 94305.
authors.forename: Abd Moain
authors.initials: AM
authors.lastname: Abu Dabrh
authors.forename: Khaled
authors.initials: K
authors.lastname: Mohammed
authors.forename: Noor
authors.initials: N
authors.lastname: Asi
authors.forename: Wigdan H
authors.initials: WH
authors.lastname: Farah
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
authors.forename: Magdoleen H
authors.initials: MH
authors.lastname: Farah
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Prokop
authors.forename: Laurence
authors.initials: L
authors.lastname: Katznelson
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
mesh_terms: D000172:Acromegaly / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult