Preoperative somatostatin analogs treatment in acromegalic patients with macroadenomas. A meta-analysis.

Abstract

BACKGROUND:

Several studies have investigated the biochemical remission rate of presurgical somatostatin analogs treatment on acromegaly, but the remission criteria were diversed and the results were contradicting.

OBJECTIVE:

Aim of this paper is to provide enhanced evidence for the effectiveness of preoperative SSA treatment to improve on surgical results of macroadenomas in acromegaly.

DATA SOURCE:

Literature is cited from the PubMed, Embase and Cochrane Library, dating from December, 1985 to August, 2013.

STUDY ELIGIBILITY CRITERIA:

Eligibility criteria included patients with acromegaly caused by GH-secreting pituitary macroadenomas, patients pretreated with somatostatin analogs versus direct surgery and a stricter remission criteria defined as the GH nadir<1μg/l during an oral glucose tolerance test (OGTT) and the age- and sex- adjusted IGF-1 concentration was normal. Primary end points included Short term and long term postoperative biochemical remission.

STUDY APPRAISAL AND SYNTHESIS METHODS:

A total of 1421 publications were found by the electronic search. After full-text review, 8 were included in our study. 7 of them focus on the postoperative remission in short term; 3 of them focus on the outcomes in long term. For the analysis of the postoperative biochemical remission, a random effect model was used to account for differences.

RESULTS:

The meta analysis shows that patients in the SSA pretreatment groups have had a more significantly cure rate than those in the direct surgery groups (RR=1.72, 95%CI: 1.14-2.60, P=0.009) with a short term follow-up. Subgroup analysis proves benefit from lanreotide pretreated groups (RR=2.27, 95%CI: 1.34-3.84, P=0.002) but not octreotide pretreated groups (RR=1.51, 95%CI: 0.82-2.75, P=0.183). No significant differences appeared between the two groups (RR=1.03, 95%CI: 0.86-1.24, P=0.751) with a long term follow-up.

LIMITATIONS:

2 Retrospective trial was included and most of the trials included was designed as single-center study.

CONCLUSIONS:

Based on the analysis of this paper, the preoperative SSA treatment was beneficial in the group with short-term follow-up, while it was not advantageous in the group with long-term follow-up. For the limitations in this study, to drawn more solid conclusions, further large, randomized, multi-center, and long-term follow-up trials were required.

• Authors: Lei Zhang, Xiaojun Wu, Yong Yan, Jun Qian, Yicheng Lu, Chun Luo
• Journal: Brain & development (Brain Dev) Vol. 37 Issue 2 Pg. 181-90 (Feb 2015) ISSN: 1872-7131 [Electronic] Netherlands
• PMID: 24815226 (Publication Type: Journal Article, Meta-Analysis)
• Copyright: Copyright © 2014 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Chemical References

• Somatostatin

Topics

• Acromegaly (complications, drug therapy)
• Adenoma (complications, drug therapy)
• Cohort Studies
• Databases, Factual (statistics & numerical data)
• Humans
• Pituitary Neoplasms (complications, drug therapy)
• Somatostatin (analogs & derivatives, therapeutic use)