2021年 · 第101卷第27期

In patients with acromegaly who are not well controlled by octreotide or lanreotide, long-acting pasireotide can effectively reduce insulin-like growth factor 1 (IGF-1) to normal levels. In order to further clarify the long-term safety and efficacy of pasireotide, including the time required to achieve biochemical control, the time required to achieve the best treatment response, and the risk of diabetes, Akirov et al. conducted a multicenter retrospective study on patients with active acromegaly treated with pasireotide for more than 12 months. Nineteen patients treated with pasireotide were included in the study [10 men; Age (48.0 ± 12.9) years; Treatment time (50 ± 36) months]. Four patients discontinued treatment with pasireotide during follow-up. During treatment with long-acting pasireotide, 15 patients (79.0%) could maintain long-term tolerance and achieve biochemical control. The time from initiation of long-acting pasireotide to normalization of IGF-1 was (13.6 ± 16.9) months, with early biochemical remission (<12 months) in 11 (64.7%) and in 6 (35.3%) with delayed biochemical remission. Six (35.3%) patients had the lowest value of IGF-1 within 12 months of treatment initiation; Eleven patients had the lowest IGF-1 values after 12 months of treatment, including four patients with early IGF-1 normalization. Of the 7 patients with prediabetes, 5 developed new onset diabetes; Of the five patients with normal glucose metabolism at baseline, one developed new onset diabetes. In patients with prediabetes or diabetes before treatment with long-acting pasireotide, glycosylated hemoglobin increased by 0.56%±1.00%. The results of this study confirm the long-term safety and efficacy of long-acting pasireotide in the treatment of acromegaly, and suggest that the normalization of IGF-1 by pasireotide treatment may have a delayed effect.

Acromegaly is a rare chronic progressive endocrine disease with insidious onset. Due to its low incidence, there are no systematic reviews and meta-analyses reported on the global epidemiology of acromegaly. Crisafulli et al. report on the global epidemiology of acromegaly through a systematic literature review and meta-analysis. By searching the MEDLINE, EMBASE, and Cochrane Library databases for studies on the epidemiology of acromegaly as of January 31, 2020. This meta-analysis incorporated original observational studies written in English reporting the prevalence and/or incidence of acromegaly in well-defined geographical areas. Two evaluators independently extracted data and conducted quality assessments. A summary of the prevalence and incidence of acromegaly was concluded. A total of 32 studies were included in the systematic review, of which 22 were included in the study. By meta-analysis, the prevalence of acromegaly was 5.9 per 100,000 people (95%CI: 4.4 to 7.9), while the incidence rate was 0.38 per 100,000 person-years (95%CI：0.32~0.44）。 Considerable study heterogeneity was found for prevalence and incidence (I²99.3% and 86.0%, respectively). Of these, 20 studies were rated as moderate for the quality of their research reports and 12 studies were rated as low for the quality of their research reports. While a significant amount of heterogeneity is due to the high accuracy of study estimates, the level of study related to data sources and geographic regions can explain approximately 50% of the total inter-study variability. Therefore, it is highly necessary to conduct large-scale, high-quality studies leading to precise epidemiological results of acromegaly to assist the public health system in decision-making.