Issue: May 2022
Disclosures: Fleseriu reports serving as a scientific consultant for Chiasma, Crinetics, Ionis, Ipsen, Pfizer and Recordati; serving as a principal investigator with support to the institution for Chiasma, Crinetics, Ionis, and Novartis. Please see the study for all other authors’ relevant financial disclosures.
April 01, 2022
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Adults with acromegaly have more comorbidities, prescribed more concomitant medications

Issue: May 2022
Disclosures: Fleseriu reports serving as a scientific consultant for Chiasma, Crinetics, Ionis, Ipsen, Pfizer and Recordati; serving as a principal investigator with support to the institution for Chiasma, Crinetics, Ionis, and Novartis. Please see the study for all other authors’ relevant financial disclosures.
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Adults with acromegaly have more comorbidities and are prescribed more concomitant medications than those without acromegaly, according to study findings published in Pituitary.

Maria Fleseriu

“Acromegaly is a rare disease with a significant delayed diagnosis, up to 10 to 11 years; thus, at diagnosis, patients already have many complications. Real-world evidence on the frequency of comorbidities in the US and prevalence of prescribed concomitant medications has been limited,” Maria Fleseriu, MD, FACE, a Healio | Endocrine Today Co-editor, professor of medicine and neurological surgery and director of the Pituitary Center at Oregon Health & Science University in Portland, told Healio. “In our large study, which included patients with acromegaly with active disease on medical therapy, hypopituitarism and hypothalamic disorders, sleep apnea, malignant neoplasms, arthritis as well as musculoskeletal disorders had high prevalence in the acromegaly cohort compared with the general population as expected. However, some rates were surprising. The proportion of patients with cerebrovascular disorders in the acromegaly cohort was nearly twice that of the matched control cohort, despite being matched for sex and age.”

Adults with acromegaly more likely to prescribed concomitant medications than healthy adults
A higher percentage of adults with acromegaly were prescribed at least three concomitant medications compared with a group of healthy adults without acromegaly. Data were derived from Fleseriu M, et al. Pituitary. 2022;doi:10.1007/s11102-021-01198-5.

Fleseriu and colleagues conducted a real-world retrospective cohort study of administrative claims data from the IBM MarketScan claims database in the U.S. from January 2010 to April 2020. A cohort of 1,175 people with at least two claims associated with acromegaly and more than 30 days between the two claims who also received at least one treatment for acromegaly were matched 1:5 with a control cohort of healthy adults without acromegaly. Comorbidities and concomitant medications were obtained from the claims database, but adherence could not be measured.

More comorbidities with acromegaly

The acromegaly cohort had a higher prevalence of cardiovascular disease (67.6% vs. 48.4%), hypopituitarism and disorders of hypothalamus (26.3% vs. 0.2%), sleep apnea (24.9% vs. 7.8%), malignant neoplasms and cancer (22.6% vs. 8.6%), and arthritis and musculoskeletal disorders (19.9% vs. 12.9%) compared with the control cohort. Those with acromegaly were also prescribed more antibacterials for systemic use (70% vs. 55.6%), analgesics (56.3% vs. 38.1%), cough and cold preparations (46.4% vs. 35.5%), psycholeptics (42.6% vs. 24.8%) and sex hormones and modulators of the genital system (37.3% vs. 12.7%) compared with controls. Of the acromegaly group, 89% were prescribed more than three concomitant medication ingredients compared with 68.3% of controls (P < .0001). A higher prevalence of the control group was prescribed zero concomitant medication ingredients compared with those with acromegaly (15% vs. 2.5%; P < .0001). A moderate positive association was observed between the number of comorbidities and the number of concomitant medication ingredients prescribed.

Oral concomitant medications were prescribed in 67.9% of the study cohort; 15.1% of medications were injectable and 17% were taken in another form. All medications in the study except lisinopril were prescribed more to the acromegaly cohort compared with controls.

Acromegaly and anticoagulants

Researchers also conducted a subanalysis of adults using prolonged anticoagulant therapy. The subanalysis included 52 adults with acromegaly receiving anticoagulants, 1,123 adults with acromegaly not receiving anticoagulants, 131 control participants receiving anticoagulants and 5,744 controls not receiving anticoagulants. In the subanalysis, those with acromegaly using anticoagulants had a higher prevalence of type 2 diabetes and malignant neoplastic disease than the other three groups. More people with acromegaly using anticoagulants were prescribed concomitant injectable medications compared with those without acromegaly using anticoagulants (88.5% vs. 67.9%; P = .0078).

Fleseriu said there are several steps providers should take when discussing acromegaly treatment with patients.

“Importantly, the first step is to actually acknowledge the medication burden on patients and to discuss at each visit to encourage medication adherence,” Fleseriu said. “Patient preference is also key for the treatment of acromegaly itself. Some patients might prefer monthly injectables, daily subcutaneous injections, while others would prefer the twice-daily oral medication. Furthermore, physicians should also consider potential risks or complications associated with different modes of administration when prescribing acromegaly therapy. For patients who are already treated with a complex regimen of oral medications that requires fasting, acromegaly medications in injectable form would be advisable, whenever possible, while for patients treated with anticoagulants, an oral or subcutaneous route of administration for additional medications may be preferred.”

For more information:

Maria Fleseriu, MD, FACE, can be reached at fleseriu@ohsu.edu.