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AcromegalyCVAcroNCT00615004

Cardiovascular Outcome After Surgery or Somatostatin Analogues

An observational study of Acromegaly, run by Federico II University at 1 site in Italy.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

A direct comparison between the results of surgery or somatostatin analogues (SSA) on cardiovascular complication in acromegaly has never been performed. Our objective is to investigate whether first-line surgery or SSA have a different outcome on cardiomyopathy after 12 months. Read more about this study

Who is it for?
Ages 18 to 85 years
Conditions the study is for
Acromegaly
How many people
215 participants
Where
1 siteItaly
Study dates
Jan 1997to Dec 2007
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: We will review all files from consecutive patients with active acromegaly coming to the Units of Endocrinology or Neurosurgery of the "Federico II" University of Naples from Jan 1st 1997 to December 31st 2006, primarily treated with either surgery or depot SSA, i.e. lanreotide (LAN) or slow-release octreotide (LAR), and with an available follow-up of at least 12 months. Due to the study design, this is a non ran-domized study. However, our routine procedure generally considers first-line treatment with SSA for 6-12 months, unless the tumors are clearly non invasive on Magnetic Resonance Imaging (MRI) and/or the patients who do not present any surgical or anesthesiological risk.

Who may be able to join

  • Patients treated with first-line surgery via trans-sphenoidal route by microscopic and/or endoscopic approach or with first-line depot SSA treatment
  • Achieving control of the disease; AND
  • With available follow-up after 12 months of treatment

Who cannot join

  • Patients receiving second surgery within 3 months from first surgery
  • Requiring combined dopamine-agonists and SSA because of a mixed GH/PRL-secreting tumor
  • Receiving the s.c. octreotide for longer than 15 days; OR
  • Requiring surgery or SSA as second-line treatment before the completion of the 12 months or with a follow-up shorter than 6 months after surgery or pharmacotherapy

Trial locations and contacts

1 site in 1 country.

Italy1 site
  • Department of Molecular and Clinical Endocrinology and Oncology, University Federico II of Naples

    Naples, Naples, 80131

Other trials in Italy

About this study

Official title: An Observational, Retrospective, Comparative Study to Investigate Differential Outcome on Cardiomyopathy Following Control of Acromegaly After Surgery or Somatostatin Analogues Given as First-Line Therapy

A direct comparison between the results of surgery or somatostatin analogues (SSA) on cardiovascular complication in acromegaly has never been performed.

Our objective is to investigate whether first-line surgery or SSA have a different outcome on cardiomyopathy after 12 months. The design of the study is retrospective, comparative, non randomized, because of ethical problems.

Read more

Setting University Hospital. All patients treated with SSA [either octreotide-LAR (10-40 mg/q28d), or lanreotide (30-120 mg/q28d); dosages up-titrated to control GH and IGF-I levels] or operated on by transsphenoidal approach. For the purposes of this study only controlled patients will be included.

Measurements Primary outcome measures were changes in left ventricular mass index (LVMi), diastolic [early to atrial mitral flow velocity (E/A)] and systolic perform-ance [LV ejection fraction (LVEF)]. Secondary outcome measures were reduction of total/HDL-cholesterol ratio, as a cardiovascular (CV) risk parameter, improvement of glucose profile and pituitary function, as indirect causes of CV improvement.

Expected results: SSA and surgery groups should have similar results in terms of improvement of cardiomyopathy. However, recent data suggest that SSA reduce directly heart rate and cardiomyocytes performance: clinical implications of these evidences suggest that SSA will improve cardiovascular outcome more than surgery. Moreover, after surgery, replacement therapy already stabilised or of new onset, has never been considered so far in this setting.

Read the detailed description

We will review all files from consecutive patients with active acromegaly coming to the Units of Endocrinology or Neurosurgery of the "Federico II" University of Naples from Jan 1st 1997 to December 31st 2006, primarily treated with either surgery or depot SSA, i.e. lanreotide (LAN) or slow-release octreotide (LAR), and with an available follow-up of at least 12 months. Due to the study design, this is a non randomized study. However, our routine procedure generally considers first-line treatment with SSA for 6-12 months, unless the tumors are clearly non invasive on Magnetic Resonance Imaging (MRI) and/or the patients who do not present any surgical or anesthesiological risk.

Cure criteria are considered according with Giustina et al. Acromegaly is considered to be controlled if mean fasting GH levels were ≤2.5 μg/liter in presence of normal IGF-I levels for sex and age. Nadir GH after oral glucose load (oGTT) ≤1 μg/liter is also an option to evaluate disease control according with the 2000 Consensus Statement. However, oGTT is generally not routinely performed in patients receiving SSA, since GH-induced glucose suppression is likely to be mediated by the endogenous somatostatin tone. To avoid ascertainment bias, disease control after surgery and SSA will be only based on fasting GH and IGF-I levels. The diagnosis of acromegaly is defined as previously reported, by high serum GH levels during a 6 hr time course, not suppressible <1 µg/l after oGTT and high plasma IGF-I levels for age [expressed as value upper limit of normal range (ULN)].

For the purpose of this study only the patients with controlled acromegaly will be included to provide a period of follow-up long enough to investigate changes in cardiomyopathy parameters.

Study protocol: As for our routine procedure, at diagnosis all the patients undergo a complete metabolic and endocrine screening. After an overnight fasting, serum IGF-I levels are assayed twice in a single sample at the time 0 of the GH profile; GH levels are calculated as the mean value of at least 5 (up to 8) samples drawn every 30 min over a period of three-six hours and the average value will be considered for the statistical analysis; fasting total cholesterol, HDL cholesterol, glucose and insulin levels are also measured. The total/HDL-cholesterol ratio, index of cardiovascular risk, is calculated.

Conditions
Acromegaly
Keywords
Acromegaly, GH, IGF-I, Octreotide-LAR, Lanreotide, Transsphenoidal surgery
Medical subject headings
Acromegaly

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

Study groups in NCT00615004
Study groupRoleWhat they receive
1-SSAAll patients receiving first-line depot SSA treatment, with either octreotide-LAR or lanreotide, achieving control of the disease, and with available follow-up after 12 months of treatment.
2-SurgeryAll patients treated with first-line surgery via trans-sphenoidal route by microscopic and/or endoscopic approach, who did not require any additional therapy for acromegaly and with available follow-up after 12 months of treatment

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Changes of left ventricular mass index (LVMi), as measure of LV hypertrophy, early to atrial mitral flow velocity (E/A), as measure of diastolic function, and left ventricular ejection fraction (LVEF), as measure of systolic function.

    Measured: 12 months

Secondary outcomes (1)
  1. Changes in the total/HDL cholesterol ratio, glucose tolerance, measured as fasting glucose levels and HOMA reduction, and improvement of pituitary function

    Measured: 12 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted14 Feb 2008 (estimated)
  2. Study startJan 1997
  3. Primary completionDec 2007
  4. Study completionDec 2007

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Retrospective
Enrolment
215 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00615004
Sponsor's protocol ID
NeuroendoUnit-7
Acronym
CVAcro
Status last verified
Dec 2007
First submitted
1 Feb 2008
Last updated
14 Feb 2008
Results posted
No
Data monitoring committee
No

Publications

  • Colao A, Lombardi G. Growth-hormone and prolactin excess. Lancet. 1998 Oct 31;352(9138):1455-61. doi: 10.1016/S0140-6736(98)03356-X.

    PubMed 9808008
  • Melmed S. Medical progress: Acromegaly. N Engl J Med. 2006 Dec 14;355(24):2558-73. doi: 10.1056/NEJMra062453. No abstract available.

    PubMed 17167139
  • Melmed S, Casanueva F, Cavagnini F, Chanson P, Frohman LA, Gaillard R, Ghigo E, Ho K, Jaquet P, Kleinberg D, Lamberts S, Laws E, Lombardi G, Sheppard MC, Thorner M, Vance ML, Wass JA, Giustina A. Consensus statement: medical management of acromegaly. Eur J Endocrinol. 2005 Dec;153(6):737-40. doi: 10.1530/eje.1.02036.

    PubMed 16322377
  • Sheppard MC. Primary medical therapy for acromegaly. Clin Endocrinol (Oxf). 2003 Apr;58(4):387-99. doi: 10.1046/j.1365-2265.2003.01734.x.

    PubMed 12641619
  • Giustina A, Barkan A, Casanueva FF, Cavagnini F, Frohman L, Ho K, Veldhuis J, Wass J, Von Werder K, Melmed S. Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab. 2000 Feb;85(2):526-9. doi: 10.1210/jcem.85.2.6363.

    PubMed 10690849
  • Colao A, Martino E, Cappabianca P, Cozzi R, Scanarini M, Ghigo E; A.L.I.C.E. Study Group. First-line therapy of acromegaly: a statement of the A.L.I.C.E. (Acromegaly primary medical treatment Learning and Improvement with Continuous Medical Education) Study Group. J Endocrinol Invest. 2006 Dec;29(11):1017-20. doi: 10.1007/BF03349217. No abstract available.

    PubMed 17259801
  • Cappabianca P, Alfieri A, Colao A, Ferone D, Lombardi G, de Divitiis E. Endoscopic endonasal transsphenoidal approach: an additional reason in support of surgery in the management of pituitary lesions. Skull Base Surg. 1999;9(2):109-17. doi: 10.1055/s-2008-1058157.

    PubMed 17171126
  • Galderisi M, Vitale G, Bianco A, Pivonello R, Lombardi G, Divitiis Od, Colao A. Pulsed tissue Doppler identifies subclinical myocardial biventricular dysfunction in active acromegaly. Clin Endocrinol (Oxf). 2006 Apr;64(4):390-7. doi: 10.1111/j.1365-2265.2006.02475.x.

    PubMed 16584510
  • Colao A, Pivonello R, Rosato F, Tita P, De Menis E, Barreca A, Ferrara R, Mainini F, Arosio M, Lombardi G. First-line octreotide-LAR therapy induces tumour shrinkage and controls hormone excess in patients with acromegaly: results from an open, prospective, multicentre trial. Clin Endocrinol (Oxf). 2006 Mar;64(3):342-51. doi: 10.1111/j.1365-2265.2006.02467.x.

    PubMed 16487447
  • Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev. 2004 Feb;25(1):102-52. doi: 10.1210/er.2002-0022.

    PubMed 14769829
  • Colao A, Auriemma RS, Savastano S, Galdiero M, Grasso LF, Lombardi G, Pivonello R. Glucose tolerance and somatostatin analog treatment in acromegaly: a 12-month study. J Clin Endocrinol Metab. 2009 Aug;94(8):2907-14. doi: 10.1210/jc.2008-2627. Epub 2009 Jun 2.

    PubMed 19491229
  • Colao A, Pivonello R, Galderisi M, Cappabianca P, Auriemma RS, Galdiero M, Cavallo LM, Esposito F, Lombardi G. Impact of treating acromegaly first with surgery or somatostatin analogs on cardiomyopathy. J Clin Endocrinol Metab. 2008 Jul;93(7):2639-46. doi: 10.1210/jc.2008-0299. Epub 2008 Apr 29.

    PubMed 18445662

Questions about this trial

What is this clinical trial studying?

An observational study of Acromegaly, run by Federico II University at 1 site in Italy.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 14 Feb 2008. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Italy. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Changes of left ventricular mass index (LVMi), as measure of LV hypertrophy, early to atrial mitral flow velocity (E/A), as measure of diastolic function, and left ventricular ejection fraction (LVEF), as measure of systolic function. (time frame: 12 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00615004, which also lists 12 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Feb 2008.

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