Insights from an Italian Delphi panel: exploring resistance to first-generation somatostatin receptor ligands and guiding second-line medical therapies in acromegaly management.

IF 5.4 2区 医学 Q1 Medicine Journal of Endocrinological Investigation Pub Date : 2024-12-01 Epub Date: 2024-05-29 DOI:10.1007/s40618-024-02386-3
S Grottoli, P Maffei, A S Tresoldi, S Granato, L Benedan, P Mariani, A Giustina
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Abstract

Purpose: First-line medical therapy for acromegaly management includes first-generation somatostatin receptor ligands (fgSRLs), but resistance limits their use. Despite international guidelines, the choice of second-line therapy is debated.

Methods: We aim to discuss resistance to fgSRLs, identify second-line therapy determinants and assess glycemia's impact to provide valuable insights for acromegaly management in clinical practice. A group of Italian endocrinologists expert in the pituitary field participated in a two-round Delphi panel between July and September 2023. The Delphi questionnaire encompassed a total of 75 statements categorized into three sections: resistance to fgSRLs therapy and predictors of response; determinants for the selection of second-line therapy; the role of glycemia in the therapeutic management. The statements were rated on a 6-point Likert scale.

Results: Fifty-nine (79%) statements reached a consensus. IGF-1 levels resulted central for evaluating resistance to fgSRLs, that should be defined considering also symptomatic clinical response, degree of tumor shrinkage and complications, using clinician- and patient-reported outcome tools available. Factors to be evaluated for the choice of second-line medical therapy are hyperglycemia-that should be managed as in non-acromegalic patients-tumor remnant, resistant headache and compliance. Costs do not represent a main determinant in the choice of second-line medical treatment.

Conclusion: The experts agreed on a holistic management approach to acromegaly. It is therefore necessary to choose currently available highly effective second-line medical treatment (pegvisomant and pasireotide) based on the characteristics of the patients.

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来自意大利德尔菲小组的见解:探索对第一代体生长抑素受体配体的抗药性,并指导肢端肥大症治疗中的二线药物疗法。
目的:治疗肢端肥大症的一线药物疗法包括第一代体生长抑素受体配体(fgSRLs),但耐药性限制了其使用。尽管制定了国际指南,但对二线疗法的选择仍存在争议:我们旨在讨论对 fgSRLs 的耐药性、确定二线疗法的决定因素并评估血糖的影响,从而为临床实践中的肢端肥大症治疗提供有价值的见解。一组垂体领域的意大利内分泌专家在2023年7月至9月期间参加了两轮德尔菲小组讨论。德尔菲问卷共包括 75 项陈述,分为三个部分:对 fgSRLs 治疗的耐药性和反应预测因素;选择二线疗法的决定因素;血糖在治疗管理中的作用。这些陈述采用 6 点李克特量表评分:结果:59 项声明(79%)达成了共识。IGF-1水平是评估对fgSRLs耐药性的核心,在界定耐药性时还应考虑症状性临床反应、肿瘤缩小程度和并发症,并使用现有的临床医生和患者报告结果工具。在选择二线药物治疗时,需要评估的因素包括高血糖(应与非血色素沉着患者一样进行管理)、肿瘤残留、耐药性头痛和依从性。费用并不是选择二线治疗的主要决定因素:专家们一致同意对肢端肥大症采取综合治疗方法。因此,有必要根据患者的特点选择目前可用的高效二线药物治疗(培维索曼和帕司瑞肽)。
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来源期刊
Journal of Endocrinological Investigation
Journal of Endocrinological Investigation ENDOCRINOLOGY & METABOLISM-
CiteScore
8.10
自引率
7.40%
发文量
242
期刊介绍: The Journal of Endocrinological Investigation is a well-established, e-only endocrine journal founded 36 years ago in 1978. It is the official journal of the Italian Society of Endocrinology (SIE), established in 1964. Other Italian societies in the endocrinology and metabolism field are affiliated to the journal: Italian Society of Andrology and Sexual Medicine, Italian Society of Obesity, Italian Society of Pediatric Endocrinology and Diabetology, Clinical Endocrinologists’ Association, Thyroid Association, Endocrine Surgical Units Association, Italian Society of Pharmacology.
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