Abstract
BackgroundPegvisomant (PEGV) is widely used, alone or with somatostatin analogs (SSA), for GH-secreting pituitary tumors poorly controlled by SSAs alone. No information is available on specific indications for or relative efficacies of PEGV?+?SSA versus PEGV monotherapy. Aim of our study was to characterize real-life clinical use of PEGV vs. PEGV?+?SSA for SSA-resistant acromegaly (patient selection, long-term outcomes, adverse event rates, doses required to achieve control).MethodsA retrospective analysis of data collected in 2005–2010 in five hospital-based endocrinology centers in Rome was performed. Sixty-two adult acromegaly patients treated ≥6 months with PEGV (Group 1, n?=?35) or PEGV?+?SSA (Group 2, n?=?27) after unsuccessful maximal-dose SSA monotherapy (≥12 months) were enroled. Groups were compared in terms of clinical/biochemical characteristics at diagnosis and before PEGV or PEGV?+?SSA was started (baseline) and end-of-follow-up outcomes (IGF-I levels, adverse event rates, final PEGV doses).ResultsGroup 2 showed higher IGF-I and GH levels and sleep apnea rates, higher rates residual tumor tissue at baseline, more substantial responses to SSA monotherapy and worse outcomes (IGF-I normalization rates, final IGF-I levels). Tumor growth and hepatotoxicity events were rare in both groups. Final daily PEGV doses were similar and significantly increased with treatment duration in both groups.ConclusionsPEGV and PEGV?+?SSA are safe, effective solutions for managing SSA-refractory acromegaly. PEGV?+?SSA tends to be used for more aggressive disease associated with detectable tumor tissue. With both regimens, ongoing monitoring of responses is important since PEGV doses needed to maintain IGF-I control are likely to increase over time.
Highlights
Pegvisomant (PEGV) is widely used, alone or with somatostatin analogs (SSA), for GH-secreting pituitary tumors poorly controlled by SSAs alone
We found that combination therapy was more likely to be prescribed for patients with clinical/biochemical/imaging evidence of relatively severe/aggressive disease along with a more substantial IGF-I response to SSA monotherapy
We found for the first time that, in SSA-refractory GHpituitary tumours, combination therapy (PEGV + SSA)
Summary
Pegvisomant (PEGV) is widely used, alone or with somatostatin analogs (SSA), for GH-secreting pituitary tumors poorly controlled by SSAs alone. The mainstay of treatment involves surgical resection of the somatotrophic adenoma causing the disease. In experienced hands, it is associated with cure rates of 50-70%, depending on the size, morphology, and location of the tumor. Pegvisomant (PEGV), a pegylated recombinant human GH analog that acts as a GH-receptor antagonist, was approved by the European Medicines Agency in 2002 for treatment of acromegaly in patients with inadequate responses (or contraindications) to surgery and/or radiation therapy and to SSA monotherapy [6]. The indications approved in 2003 by the U.S Food and Drug Administration were somewhat broader and included patients who could not be controlled (or tolerate) surgery and/or radiation and/or other medical therapies [7]. Numerous studies have documented PEGV’s efficacy in patients with persistent active acromegaly, with IGF-I normalization rates ranging from 63% to 97% [8,9,10,11]
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