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Surgical Interventions and Medical Treatments in Treatment-Naive Patients With Acromegaly: Systematic Review and Meta-Analysis JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM Abu Dabrh, A. M., Mohammed, K., Asi, N., Farah, W. H., Wang, Z., Farah, M. H., Prokop, L. J., Katznelson, L., Murad, M. H. 2014; 99 (11): 4003-4014

Abstract

Acromegaly is usually treated with surgery as a first-line treatment, although medical therapy has also been used as an alternative primary treatment.We conducted a systematic review and meta-analysis to synthesize the existing evidence comparing these two approaches in treatment-naïve patients with acromegaly.This study performed a comprehensive search in multiple databases, including Medline, EMBASE, and Scopus from early inception through April 2014.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.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.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 of GH (65% vs 46%; P = .05). In one study, the IGF-1 level was reduced more with surgery compared with medical treatment (-731 µg/L vs -251 µg/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).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.

View details for DOI 10.1210/jc.2014-2900

View details for Web of Science ID 000346743100013

View details for PubMedID 25356809