Treatment Patterns, Adherence, Persistence, and Health Care Resource Utilization in Acromegaly: A Real-World Analysis

Maria Fleseriu; Ariel Barkan; Thierry Brue; Edouard Duquesne; Aude Houchard; Maria Del Pilar Schneider; Antonio Ribeiro-Oliveira Jr; Shlomo Melmed

doi:10.1210/jendso/bvad104

Treatment Patterns, Adherence, Persistence, and Health Care Resource Utilization in Acromegaly: A Real-World Analysis

J Endocr Soc. 2023 Aug 23;7(10):bvad104. doi: 10.1210/jendso/bvad104. eCollection 2023 Aug 28.

Authors

Maria Fleseriu¹, Ariel Barkan², Thierry Brue³, Edouard Duquesne⁴, Aude Houchard⁵, Maria Del Pilar Schneider⁶, Antonio Ribeiro-Oliveira Jr⁷, Shlomo Melmed⁸

Affiliations

¹ Pituitary Center, Departments of Medicine and Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
² A. Alfred Taubman Health Care Center, University of Michigan, Ann Arbor, MI 48109, USA.
³ Faculté de Médecine, Aix-Marseille University, Marseille 13385, France.
⁴ Ipsen, Digital Department, Boulogne-Billancourt 92100, France.
⁵ Ipsen, HEOR Oncology Department, Boulogne-Billancourt 92100, France.
⁶ Biometry Department, Ipsen, Les Ulis 91940, France.
⁷ Global Medical Affairs Department, Ipsen, Cambridge, MA 02142, USA.
⁸ Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.

Abstract

Context: Treatment of acromegaly is multimodal for many patients, and medical treatments include somatostatin receptor ligands (SRLs), dopamine agonists (DAs), and growth hormone receptor antagonists (GHRAs). However, recent real-world evidence on treatment patterns for patients with acromegaly is limited.

Objective: This study evaluated medication usage, treatment changes, adherence, persistence, comorbidities, and health care resource utilization using deidentified data from MarketScan, a US claims database.

Methods: Eligible patients (n = 882) were those receiving monotherapy or combination therapy for ≥90 days without treatment gaps.

Results: Mean age at diagnosis was 48.6 years; 50.1% of patients were female. Over half (59.4%) had 1 line of treatment (LOT); 23.1% had 2 LOTs; 17.5% had at least 3 LOTs. Most patients (94.6%) initiated treatment with monotherapies. The most common first-line monotherapy treatments were cabergoline (DA, 36.8%), octreotide long-acting release (first-generation SRL, 29.5%), and lanreotide depot (first-generation SRL, 22.5%). Adherence for first-line treatments (proportion of days covered) was higher for first-generation SRLs (lanreotide depot: 0.8) compared with DAs (0.7). Treatment persistence (time between the first treatment record and a change in LOT/censoring) in LOT 1 was higher for GHRAs (24.8 months) and first-generation SRLs (20.0 months) compared with DAs (14.4 months). Female patients and those diagnosed at a younger age were more likely to have shorter treatment persistence. The most prevalent comorbidities were hyperlipidemia, essential hypertension, and sleep apnea.

Conclusion: Patients with more comorbidities had more health care visits during the first year after diagnosis, suggesting increased disease burden. Real-world evidence on treatment patterns provides insights into recommendations for individualized therapy.

Keywords: acromegaly; adherence; comorbidities; health care resource utilization; persistence; real-world evidence.