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Acromegaly management in the Nordic countries: A Delphi consensus survey

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Title: Acromegaly management in the Nordic countries: A Delphi consensus survey
Authors: Arlien-Søborg, Mai C., Dal, Jakob, Heck, Ansgar, Stochholm, Kirstine, Husted, Eigil, Feltoft, Claus Larsen, Rasmussen, Åse Krogh, Feldt-Rasmussen, Ulla, Andreassen, Mikkel, Klose, Marianne Christina, Nielsen, Torben Leo, Andersen, Marianne Skovsager, Christensen, Louise Lehmann, Krogh, Jesper, Jarlov, Anne, Bollerslev, Jens, Nermoen, Ingrid, Oksnes, Marianne, Dahlqvist, Per, Olsson, Tommy, Berinder, Katarina, Hoybye, Charlotte, Petersson, Maria, Akerman, Anna karin, Wahlberg, Jeanette, Ekman, Bertil, Engstrom, Britt Eden, Johannsson, Gudmundur, Ragnarsson, Oskar, Olsson, Daniel, Sigurjónsdóttir, Helga Ágústa, Fougner, Stine Lyngvi, Matikainen, Niina, Vehkavaara, Satu, Metso, Saara, Jaatinen, Pia, Hämäläinen, Päivi, Rintamäki, Reeta, Yliaska, Iina, Immonen, Heidi, Mäkimattila, Sari, Cederberg-Tamminen, Henna, Viukari, Marianna, Nevalainen, Pasi, Nuutila, Pirjo, Schalin-Jäntti, Camilla, Burman, Pia, Jørgensen, Jens Otto Lunde
Contributors: HUS Abdominal Center, Clinicum, Endokrinologian yksikkö, HUS Internal Medicine and Rehabilitation
Publisher Information: Wiley Blackwell
Publication Year: 2024
Collection: Helsingfors Universitet: HELDA – Helsingin yliopiston digitaalinen arkisto
Subject Terms: acromegaly, Delphi, dopamine agonist, growth hormone, growth hormone receptor antagonist, insulin-like growth factor i, somatostatin, General medicine, internal medicine and other clinical medicine
Description: Objective: Acromegaly is associated with increased morbidity and mortality if left untreated. The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow-up exist. However, not all recommendations are strictly evidence-based. To evaluate consensus on the treatment and follow-up of patients with acromegaly in the Nordic countries. Methods: A Delphi process was used to map the landscape of acromegaly management in Denmark, Sweden, Norway, Finland, and Iceland. An expert panel developed 37 statements on the treatment and follow-up of patients with acromegaly. Dedicated endocrinologists (n = 47) from the Nordic countries were invited to rate their extent of agreement with the statements, using a Likert-type scale (1−7). Consensus was defined as ≥80% of panelists rating their agreement as ≥5 or ≤3 on the Likert-type scale. Results: Consensus was reached in 41% (15/37) of the statements. Panelists agreed that pituitary surgery remains first line treatment. There was general agreement to recommend first-generation somatostatin analog (SSA) treatment after failed surgery and to consider repeat surgery. In addition, there was agreement to recommend combination therapy with first-generation SSA and pegvisomant as second- or third-line treatment. In more than 50% of the statements, consensus was not achieved. Considerable disagreement existed regarding pegvisomant monotherapy, and treatment with pasireotide and dopamine agonists. Conclusion: This consensus exploration study on the management of patients with acromegaly in the Nordic countries revealed a relatively large degree of disagreement among experts, which mirrors the complexity of the disease and the shortage of evidence-based data. ; Peer reviewed
Document Type: article in journal/newspaper
File Description: application/pdf
Language: English
Relation: Jens Otto Lunde J\u00F8rgensen and Jakob Dal have received unrestricted research grants and lecture fees from Pfizer and IPSEN. Mai C. Arlien\u2010S\u00F8borg has received lecture fees from Pfizer. Daniel Olsson has served as a consultant for Ipsen, Pfizer, Novo Nordisk, and Sandoz; has received research grants from Sandoz and Pfizer; and is an employee at AstraZeneca as of 30 August 2021. This work was supported by an unrestricted research grant from Pfizer. The other authors declare no conflict of interest.; http://hdl.handle.net/10138/585324; 85195918201; 001244261400001
Availability: http://hdl.handle.net/10138/585324
Rights: cc_by_nc_nd ; info:eu-repo/semantics/openAccess ; openAccess
Accession Number: edsbas.A969F2F
Database: BASE
Description
Abstract:Objective: Acromegaly is associated with increased morbidity and mortality if left untreated. The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow-up exist. However, not all recommendations are strictly evidence-based. To evaluate consensus on the treatment and follow-up of patients with acromegaly in the Nordic countries. Methods: A Delphi process was used to map the landscape of acromegaly management in Denmark, Sweden, Norway, Finland, and Iceland. An expert panel developed 37 statements on the treatment and follow-up of patients with acromegaly. Dedicated endocrinologists (n = 47) from the Nordic countries were invited to rate their extent of agreement with the statements, using a Likert-type scale (1−7). Consensus was defined as ≥80% of panelists rating their agreement as ≥5 or ≤3 on the Likert-type scale. Results: Consensus was reached in 41% (15/37) of the statements. Panelists agreed that pituitary surgery remains first line treatment. There was general agreement to recommend first-generation somatostatin analog (SSA) treatment after failed surgery and to consider repeat surgery. In addition, there was agreement to recommend combination therapy with first-generation SSA and pegvisomant as second- or third-line treatment. In more than 50% of the statements, consensus was not achieved. Considerable disagreement existed regarding pegvisomant monotherapy, and treatment with pasireotide and dopamine agonists. Conclusion: This consensus exploration study on the management of patients with acromegaly in the Nordic countries revealed a relatively large degree of disagreement among experts, which mirrors the complexity of the disease and the shortage of evidence-based data. ; Peer reviewed