Lee Seo Young, Kim Jung Hee, Lee Ji Hyun, Kim Yong Hwy, Cha Hyang Jin, Kim Sang Wan, Paek Sun Ha, Shin Chan Soo
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Pituitary Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
Endocr J. 2018 Jan 30;65(1):33-41. doi: 10.1507/endocrj.EJ17-0125. Epub 2017 Sep 20.
Although somatostatin analogues (SSAs) are recommended as the first-line medical therapy for acromegaly, dopamine agonists (DAs) are also a therapeutic option for treatment. We aimed to assess and compare the efficacies of DAs and SSAs in treating acromegaly in clinical practice. We included 89 patients with acromegaly who took DAs (bromocriptine [BCT], n = 63; cabergoline [CAB], n = 11) or SSAs (n = 15) as a primary medical therapy for more than 3 months in the Seoul National University Hospital. The CAB (45.5%) and SSA (33.3%) groups achieved random GH levels of <2.5 ng/mL and the normal IGF-1 levels were significantly higher than in the BCT group (11.1%) (p = 0.009). We further included all the patients with acromegaly (n = 132) who had taken CAB, BCT, and SSAs as first- or second-line medical therapy. The CAB group showed similar efficacy as the SSA group in terms of the GH and insulin-like growth factor-1 (IGF-1) levels (57.6% for random GH level <2.5 ng/mL, 42.4% for normal IGF-1 levels, 36.4% for both). Logistic regression analysis revealed that medications, age, GH level, or IGF-1 level before medication, hyperprolactinemia, and prior gamma-knife surgery or radiation therapy, did not affect the therapeutic response. High pretreatment GH levels predicted poor treatment outcomes (odds ratio [95% confidence interval] = 0.95 [0.90-0.99]). CAB was effective in treating acromegaly at a relatively lower cost in patients with low pretreatment GH levels.
尽管生长抑素类似物（SSAs）被推荐为肢端肥大症的一线药物治疗，但多巴胺激动剂（DAs）也是一种治疗选择。我们旨在评估和比较DAs和SSAs在临床实践中治疗肢端肥大症的疗效。我们纳入了89例在首尔国立大学医院接受DAs（溴隐亭[BCT]，n = 63；卡麦角林[CAB]，n = 11）或SSAs（n = 15）作为主要药物治疗超过3个月的肢端肥大症患者。CAB组（45.5%）和SSA组（33.3%）的随机生长激素（GH）水平<2.5 ng/mL，且正常胰岛素样生长因子-1（IGF-1）水平显著高于BCT组（11.1%）（p = 0.009）。我们进一步纳入了所有接受CAB、BCT和SSAs作为一线或二线药物治疗的肢端肥大症患者（n = 132）。就GH和胰岛素样生长因子-1（IGF-1）水平而言，CAB组与SSA组显示出相似的疗效（随机GH水平<2.5 ng/mL为57.6%，正常IGF-1水平为42.4%，两者均正常为36.4%）。逻辑回归分析显示，药物、年龄、用药前的GH水平或IGF-1水平、高泌乳素血症以及先前的伽玛刀手术或放射治疗，均不影响治疗反应。用药前GH水平高预示治疗效果差（比值比[95%置信区间]=0.95[0.90 - 0.99]）。对于用药前GH水平低的患者，CAB以相对较低的成本有效治疗肢端肥大症。
