Annamaria Colao1, Silvia Vandeva2, Rosario Pivonello2, Ludovica Francesca Stella Grasso2, Emil Nachev2, Renata S Auriemma2, Krasimir Kalinov2, Sabina Zacharieva2. 1. Dipartimento di Medicina Clinica e ChirurgiaSezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131 Naples, ItalyClinical Center of Endocrinology and Gerontology 'Akad. Ivan Pentchev' Medical University Sofia2 Zdrave Street, 1431 Sofia, BulgariaNew Bulgarian University21 Montevideo Street, 1618 Sofia, Bulgaria colao@unina.it. 2. Dipartimento di Medicina Clinica e ChirurgiaSezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131 Naples, ItalyClinical Center of Endocrinology and Gerontology 'Akad. Ivan Pentchev' Medical University Sofia2 Zdrave Street, 1431 Sofia, BulgariaNew Bulgarian University21 Montevideo Street, 1618 Sofia, Bulgaria.
Abstract
BACKGROUND: Mortality in acromegaly strictly depends on optimal control of GH and IGF1 levels. Modern medical therapy with somatostatin analogs (SSAs) and GH receptor antagonists (GHRAs) is not available in many countries due to funding restrictions. This retrospective, comparative, cohort study investigated the impact of different treatment modalities on disease control (GH and IGF1) and mortality in acromegaly patients. METHODS: Two cohorts of patients with acromegaly from Bulgaria (n=407) and Campania, Italy (n=220), were compared, and mortality rates were evaluated during a 10-year period (1999-2008). RESULTS: The major difference in treatment approach between cohorts was the higher utilization of SSAs and GHRAs in Italy, leading to a decreased requirement for radiotherapy. Significantly more Italian than Bulgarian patients had achieved disease control (50.1 vs 39.1%, P=0.005) at the last follow-up. Compared with the general population, the Bulgarian cohort had a decreased life expectancy with a standardized mortality ratio (SMR) of 2.0 (95% CI 1.54-2.47) that was restored to normal in patients with disease control - SMR 1.25 (95% CI 0.68-1.81). Irradiated patients had a higher cerebrovascular mortality - SMR 7.15 (95% CI 2.92-11.37). Internal analysis revealed an independent role of age at diagnosis and last GH value on all-cause mortality and radiotherapy on cerebrovascular mortality. Normal survival rates were observed in the Italian cohort: SMR 0.66 (95% CI 0.27-1.36). CONCLUSIONS: Suboptimal biochemical control was associated with a higher mortality in the Bulgarian cohort. Modern treatment options that induce a strict biochemical control and reduce the necessity of radiotherapy might influence the life expectancy. Other factors, possibly management of comorbidities, could contribute to survival rates.
BACKGROUND: Mortality in acromegaly strictly depends on optimal control of GH and IGF1 levels. Modern medical therapy with somatostatin analogs (SSAs) and GH receptor antagonists (GHRAs) is not available in many countries due to funding restrictions. This retrospective, comparative, cohort study investigated the impact of different treatment modalities on disease control (GH and IGF1) and mortality in acromegalypatients. METHODS: Two cohorts of patients with acromegaly from Bulgaria (n=407) and Campania, Italy (n=220), were compared, and mortality rates were evaluated during a 10-year period (1999-2008). RESULTS: The major difference in treatment approach between cohorts was the higher utilization of SSAs and GHRAs in Italy, leading to a decreased requirement for radiotherapy. Significantly more Italian than Bulgarian patients had achieved disease control (50.1 vs 39.1%, P=0.005) at the last follow-up. Compared with the general population, the Bulgarian cohort had a decreased life expectancy with a standardized mortality ratio (SMR) of 2.0 (95% CI 1.54-2.47) that was restored to normal in patients with disease control - SMR 1.25 (95% CI 0.68-1.81). Irradiated patients had a higher cerebrovascular mortality - SMR 7.15 (95% CI 2.92-11.37). Internal analysis revealed an independent role of age at diagnosis and last GH value on all-cause mortality and radiotherapy on cerebrovascular mortality. Normal survival rates were observed in the Italian cohort: SMR 0.66 (95% CI 0.27-1.36). CONCLUSIONS: Suboptimal biochemical control was associated with a higher mortality in the Bulgarian cohort. Modern treatment options that induce a strict biochemical control and reduce the necessity of radiotherapy might influence the life expectancy. Other factors, possibly management of comorbidities, could contribute to survival rates.
Authors: Elena V Varlamov; Dan Alexandru Niculescu; Swechya Banskota; Simona Andreea Galoiu; Catalina Poiana; Maria Fleseriu Journal: Endocr Connect Date: 2021-07-05 Impact factor: 3.335
Authors: Annamaria Colao; Marcello D Bronstein; Thierry Brue; Laura De Marinis; Maria Fleseriu; Mirtha Guitelman; Gerald Raverot; Ilan Shimon; Jürgen Fleck; Pritam Gupta; Alberto M Pedroncelli; Mônica R Gadelha Journal: Eur J Endocrinol Date: 2020-06 Impact factor: 6.664
Authors: Maria Kamusheva; Silvia Vandeva; Konstantin Mitov; Yanitsa Rusenova; Atanaska Elenkova; Sabina Zacharieva; Zornitsa Mitkova; Konstantin Tachkov; Maria Dimitrova; Miglena Doneva; Dimitar Tcharaktchiev; Guenka Petrova Journal: Front Public Health Date: 2020-04-28