Efficacy and safety of pharmacologic therapies in acromegaly: a systematic literature review and network meta-analysis.

Background

Systematically review the efficacy and safety of pharmacological treatments for acromegaly and conduct a network meta-analysis(NMA) enabling indirect comparisons.

系统回顾药物治疗肢端肥大症的有效性和安全性，并进行网络荟萃分析（NMA），以实现间接比较。

Methods

MEDLINE and Embase were searched to identify randomized controlled trials (RCTs) of acromegaly therapies.

通过MEDLINE和Embase检索，以确定肢端肥大症治疗的随机对照试验（RCTs）。

Screening and data extraction followed PRISMA guidelines.

筛选和数据提取遵循PRISMA指南。

Feasibility assessment evaluated homogeneity and consistency assumptions required for NMA.

可行性评估评估了网络荟萃分析(NMA)所需的同质性和一致性假设。

Bayesian NMAs estimated relative treatment effects and ranking probabilities.

贝叶斯网络荟萃分析估计了相对治疗效果和排名概率。

Results

Twenty-two records covering 18 RCTs were included.

纳入了涵盖18项随机对照试验（RCTs）的22个记录。

Biochemical control rates were comparable among long-acting injectable somatostatin receptor ligands (SRLs), including lanreotide autogel (LAN-ATG), octreotide long-acting release (OCT-LAR), pasireotide, the GH receptor antagonist pegvisomant, oral octreotide (O-OCT), octreotide subcutaneous depot (SC-OCT-D), and the once-daily oral SRL paltusotine.

在长效注射型生长抑素受体配体（SRLs）之间，包括兰瑞肽自体凝胶（LAN-ATG）、奥曲肽长效释放剂（OCT-LAR）、帕瑞肽、GH受体拮抗剂佩格维莫单、口服奥曲肽（O-OCT）、奥曲肽皮下注射库（SC-OCT-D）以及每日一次口服SRL帕尔图索汀之间，生化控制率是可比的。

Paltusotine demonstrated significantly higher biochemical control vs O-OCT and SC-OCT-D (odds ratios [ORs], 95% credible intervals [CrIs]: 7.34 [1.48-36.07] and 7.85 [1.72, 36.25]).

Paltusotine显示出与O-OCT和SC-OCT-D相比显著更高的生化控制率（比值比[ORs]，95%可信区间[CrIs]：7.34 [1.48-36.07]和7.85 [1.72, 36.25]）。

Pasireotide showed significantly higher biochemical control vs OCT-LAR (OR: 2.03 [1.29-3.23]).

Pasireotide显示出与OCT-LAR相比显著更高的生化控制率（OR: 2.03 [1.29-3.23]）。

Paltusotine had significantly lower discontinuations due to adverse events (AEs) vs O-OCT and SC-OCT-D, (ORs: 0.022 [0.001-0.424] and 0.022 [0.001-0.343]), with similar rates to other treatments.

Paltusotine因不良事件导致的停药率显著低于O-OCT和SC-OCT-D（比值比：0.022 [95% CI 0.001-0.424] 和 0.022 [95% CI 0.001-0.343]），与其他治疗的停药率相似。

Treatment-emergent AEs (TEAEs) and serious TEAEs were comparable across treatments.

治疗后出现的不良事件（TEAEs）和严重TEAEs在各治疗组之间是可比的。

Rankings suggested paltusotine as the treatment with the highest probability of ranking as the most effective (or tolerable) treatment across all endpoints studied.

排名显示，paltusotine 在所有研究终点中被认定为最有效（或最耐受）的治疗方式的可能性最高。

Conclusions

This systematic reviewand NMA consolidate recent high-quality RCT evidence for acromegaly treatments.

这项系统评价和网络荟萃分析整合了近期关于肢端肥大症治疗的高质量随机对照试验的证据。

Paltusotine emerges as a promising alternative to injectable SRLs, with favorable efficacy, safety, and AE-related discontinuation patterns.

Paltusotine 作为一种有前景的替代品，与注射型 SRLs 相比，在疗效、安全性和与不良事件相关的停药模式方面均显示出优势。

These findings may inform clinical decision-making and guideline development, if confirmed by clinical experience.

如果这些发现通过临床经验得到证实，它们可能会为临床决策和指南制定提供信息。