Evidence-based guidelines in acromegaly: implications on the clinic

ABSTRACT

Acromegaly is a rare disease with many challenges in its management. In order to address these challenges, many clinical practice guidelines were recently published. They were based on the literature evidence, aiming at guiding primary care physicians, general endocrinologists and neuroendocrinologists. The majority of these guidelines were developed following the GRADE system that classifies the recommendations according to strength (weak or strong) and quality of the evidence that supports them. In this review, we discuss how the evidence-based guidelines are developed, how to interpret the different strengths of recommendations and discuss the clinical implications of the evidence-based guidelines in acromegaly, pointing its utility and limitations on the diagnosis, management of comorbidities and in the disease treatment.

KEYWORDS:

• Acromegaly
• clinical guidelines
• evidence-based medicine
• GRADE system
• acromegaly treatment

Financial & competing interests disclosure

M.R. Gadelha has received unrestricted research grants and speaker fees from Novartis, Ipsen and Pfizer and has participated on advisory boards of Novartis and Ipsen. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Recommendations in the guidelines are based in different levels of evidence in the literature. This should be considered when analyzing a guideline.

• Strong recommendation implies that the intervention is clearly beneficial to the patient.

• Weak recommendation for an intervention means that it may differ depending on the circumstance or even that other alternatives may be reasonable.

• Clinical guidelines are supposed to be guides, not rules, for acromegaly management.

• Guidelines provide standardization of diagnostic criteria of acromegaly, as well as the criteria for disease control.

• When applying a recommendation to the clinical practice, attention should be given to the difference between the conditions that based the recommendations and the ones found in ‘real life,’ as for example the lack of experienced neurosurgeons in many centers.

• The guidelines recommendations should be interpreted considering the particularities of each patient being treated in order to advance toward a more personalized medicine.