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What is the efficacy of switching to weekly pegvisomant in acromegaly patients well controlled on combination therapy?
Muhammad, A; van der Lely, A J; O'Connor, R D; Delhanty, P J; Dal, J; Dallenga, A H; Feelders, R A; Janssen, J A M J L; Jorgensen, J O L; Neggers, S J C M M.
Afiliación
  • Muhammad A; Endocrinology SectionDepartment of Medicine, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands a.muhammad.1@erasmusmc.nl.
  • van der Lely AJ; Endocrinology SectionDepartment of Medicine, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands.
  • O'Connor RD; Endocrinology SectionDepartment of Medicine, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands.
  • Delhanty PJ; Endocrinology SectionDepartment of Medicine, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands.
  • Dal J; Medical Department (Endocrinology and Diabetes)Medical Research Laboratories, Clinical Institute, Aarhus, Denmark.
  • Dallenga AH; Endocrinology SectionDepartment of Medicine, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands.
  • Feelders RA; Endocrinology SectionDepartment of Medicine, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands.
  • Janssen JA; Endocrinology SectionDepartment of Medicine, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands.
  • Jorgensen JO; Medical Department (Endocrinology and Diabetes)Medical Research Laboratories, Clinical Institute, Aarhus, Denmark.
  • Neggers SJ; Endocrinology SectionDepartment of Medicine, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands.
Eur J Endocrinol ; 174(5): 663-7, 2016 May.
Article en En | MEDLINE | ID: mdl-26903550
CONTEXT: Although combination therapy of acromegaly with long-acting somatostatin analogs (LA-SSAs) and pegvisomant (PEGV) normalizes insulin-like growth factor-1 (IGF1) levels in the majority of patients, it requires long-term adherence. Switching from combination therapy to monotherapy with weekly PEGV could improve patients' comfort, but the efficacy is unknown. OBJECTIVE: To assess the efficacy of switching to PEGV monotherapy in patients well controlled on combination therapy of LA-SSAs and PEGV. DESIGN: Single-center, open-label observational pilot study. LA-SSA therapy was discontinued at baseline and all patients were switched to PEGV monotherapy for 12 months. If IGF1 levels exceeded 1.0 times upper limit of normal (ULN), PEGV dose was increased by 20 mg weekly. SUBJECTS AND METHODS: The study included 15 subjects (eight males), with a median age of 58 years (range 35-80) on combination therapy of high-dose LA-SSAs and weekly PEGV for >6 months, and IGF1 levels within the normal range. Treatment efficacy was assessed by measuring serum IGF1 levels. RESULTS: After 12 months of weekly PEGV monotherapy, serum IGF1 levels of 73% of the subjects remained controlled. In one patient, LA-SSA had to be restarted due to recurrence of headache. IGF1 levels increased from a baseline level of 0.62 × ULN (range 0.30-0.84) to 0.83 × ULN (0.30-1.75) after 12 months, while the median weekly PEGV dose increased from 60 (30-80) mg to 80 (50-120) mg. CONCLUSION: Our results suggest that switching from combination therapy of LA-SSAs and PEGV to PEGV monotherapy can be a viable treatment option for acromegaly patients without compromising efficacy.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Acromegalia / Factor I del Crecimiento Similar a la Insulina / Somatostatina / Evaluación de Resultado en la Atención de Salud / Hormona de Crecimiento Humana Tipo de estudio: Observational_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Eur J Endocrinol Asunto de la revista: ENDOCRINOLOGIA Año: 2016 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Reino Unido
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Acromegalia / Factor I del Crecimiento Similar a la Insulina / Somatostatina / Evaluación de Resultado en la Atención de Salud / Hormona de Crecimiento Humana Tipo de estudio: Observational_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Eur J Endocrinol Asunto de la revista: ENDOCRINOLOGIA Año: 2016 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Reino Unido