Surgical interventions and medical treatments in treatment-naïve patients with acromegaly: Systematic review and meta-analysis

Abd Moain Abu Dabrh, Khaled Mohammed, Noor Asi, Wigdan H. Farah, Zhen Wang, Magdoleen H. Farah, Larry J. Prokop, Laurence Katznelson, Mohammad H Murad

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Context: Acromegaly is usually treated with surgery as a first-line treatment, although medical therapy has also been used as an alternative primary treatment.

Objective: Weconducted a systematic review and meta-analysis to synthesize the existing evidence comparing these two approaches in treatment-naïve patients with acromegaly.

Data Sources: This study performed a comprehensive search in multiple databases, including Medline, EMBASE, and Scopus from early inception through April 2014.

Study Selection: 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.

Data Extraction: 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.

Data Synthesis: 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) (53% vs 26%; P = .02). Surgery had higher remission rates in the follow-up levels ofGH(65% vs 46%; P=.05). In one study, the IGF-1 level was reduced more with surgery compared with medical treatment (-731μg/L vs-251μg/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.

Original languageEnglish (US)
Pages (from-to)4003-4014
Number of pages12
JournalJournal of Clinical Endocrinology and Metabolism
Volume99
Issue number11
DOIs
StatePublished - Nov 1 2014

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Patient treatment
Acromegaly
Surgery
Meta-Analysis
Insulin-Like Growth Factor I
Therapeutics
Information Storage and Retrieval
Databases

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism
  • Medicine(all)

Cite this

Surgical interventions and medical treatments in treatment-naïve patients with acromegaly : Systematic review and meta-analysis. / Abu Dabrh, Abd Moain; Mohammed, Khaled; Asi, Noor; Farah, Wigdan H.; Wang, Zhen; Farah, Magdoleen H.; Prokop, Larry J.; Katznelson, Laurence; Murad, Mohammad H.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 99, No. 11, 01.11.2014, p. 4003-4014.

Research output: Contribution to journalArticle

Abu Dabrh, Abd Moain ; Mohammed, Khaled ; Asi, Noor ; Farah, Wigdan H. ; Wang, Zhen ; Farah, Magdoleen H. ; Prokop, Larry J. ; Katznelson, Laurence ; Murad, Mohammad H. / Surgical interventions and medical treatments in treatment-naïve patients with acromegaly : Systematic review and meta-analysis. In: Journal of Clinical Endocrinology and Metabolism. 2014 ; Vol. 99, No. 11. pp. 4003-4014.
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abstract = "Context: Acromegaly is usually treated with surgery as a first-line treatment, although medical therapy has also been used as an alternative primary treatment.Objective: Weconducted a systematic review and meta-analysis to synthesize the existing evidence comparing these two approaches in treatment-na{\"i}ve patients with acromegaly.Data Sources: This study performed a comprehensive search in multiple databases, including Medline, EMBASE, and Scopus from early inception through April 2014.Study Selection: 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.Data Extraction: 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.Data Synthesis: 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) (53{\%} vs 26{\%}; P = .02). Surgery had higher remission rates in the follow-up levels ofGH(65{\%} vs 46{\%}; P=.05). In one study, the IGF-1 level was reduced more with surgery compared with medical treatment (-731μg/L vs-251μg/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.",
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