Symptom severity and exacerbation frequency in medically treated patients with acromegaly

PURPOSE: To quantify the severity, frequency of symptom exacerbations, and associated life impact of acromegaly symptoms in patients treated with injected depot somatostatin receptor ligands (SRLs). METHODS: Patients receiving depot SRLs completed daily 24-hour recall surveys for 3 months. The daily surveys assessed the severity of 7 core symptoms and 2 additional symptoms on numeric scales (0-10). Symptom exacerbation was defined as a ≥ 2-point increase in any symptom score, comparing the current 2-day average with the prior 2-day average. Patients completed a final survey assessing 3-month recall of symptom severity and daily functioning, treatment satisfaction, and healthcare resource utilization (HCRU). RESULTS: The analysis population included 31 patients: mean (SD) age was 53.4 (13.6) years; 24 (77.4%) were female; 15 (48.4%) were receiving SRL monotherapy and 16 (51.6%) SRL plus non-SRL therapy. Three-month recall overestimated symptom severity relative to daily ratings and did not capture exacerbation frequency. Symptom exacerbations assessed via daily surveys occurred, on average, on 32.1% of days (> 2 days/week) throughout the injection cycle. Greater total and individual symptom severity and exacerbation frequency were related to greater life interference, including impaired daily activities, reduced work productivity, reduced treatment satisfaction, diminished life satisfaction, and increased HCRU. CONCLUSION: In patients with acromegaly treated with injected depot SRLs, symptom exacerbations occurred frequently. Symptom severity and exacerbation frequency were associated with impaired daily functioning and reduced life satisfaction. A simple daily symptom assessment provides clinically meaningful information about adequacy of disease control that is not captured by longer-term recall.