Pegvisomant in combination or pegvisomant alone after failure of somatostatin analogs in acromegaly patients: an observa
- PDF / 702,090 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 77 Downloads / 199 Views
ORIGINAL ARTICLE
Pegvisomant in combination or pegvisomant alone after failure of somatostatin analogs in acromegaly patients: an observational French ACROSTUDY cohort study Emmanuelle Kuhn1,2 Philippe Caron3 Brigitte Delemer4 Isabelle Raingeard5 Hervé Lefebvre6 Gérald Raverot7 Christine Cortet-Rudelli8 Rachel Desailloud9 Clementine Geffroy10 Robin Henocque10 Yves Brault10 Thierry Brue11 Philippe Chanson 1,2 ●
●
●
●
●
●
●
●
●
●
●
●
1234567890();,:
1234567890();,:
Received: 6 June 2020 / Accepted: 14 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objective After surgery, when somatostatin analogs (SAs) do not normalise IGF-I, pegvisomant (PEG) is indicated. Our aim was to define the medical reasons for the treatment of patients with PEG as monotherapy (M) or combined with SA, either as primary bitherapy, PB (PEG is secondarily introduced after SA) or as secondary bitherapy, SB (SAs secondarily introduced after PEG). Methods We retrospectively analysed French data from ACROSTUDY. Results 167, 88 and 57 patients were treated with M, PB or SB, respectively, during a median time of 80, 42 and 70 months. The median PEG dose was respectively 15, 10 and 20 mg. Before PEG, the mean IGF-I level did not differ between M and PB but the proportion of patients with suprasellar tumour extension was higher in PB group (67.5% vs. 44.4%, P = 0.022). SB regimen was used preferentially in patients with tumour increase and IGF-I level difficult to normalise under PEG. In both secondary regimens, the decrease of the frequency of PEG’s injections, compared to monotherapy was confirmed. However, the mean weekly dose of PEG between M and PB remained the same. Conclusions The medical rationale for continuing SAs rather than switching to PEG alone in patients who do not normalise IGF-I under SAs was a tumour concern with suprasellar extension and tumour shrinkage under SA. A potential explanation for introducing SA in association with PEG appears to be a tumour enlargement and difficulties to normalise IGF-I levels under PEG given alone. In both regimens, the prospect of lowering PEG injection frequency favoured the choice. Keywords Acromegaly GH receptor antagonist Somatostatin analogs Combination therapy ●
●
●
* Philippe Chanson [email protected] 1
Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Centre de Référence des Maladies Rares de l’Hypophyse HYPO, 94275 Le Kremlin-Bicêtre, France
Lapeyronie, 295 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France 6
CHU de Rouen, 1 Rue de Germont, 76031 Rouen Cedex, France
7
Hospices civils de Lyon, Hôpital Louis Pradel, 59 Boulevard Pinel, 69677 Bron Cedex, France
8
CHR Lille, Hôpital Claude Huriez, Rue Michel Polonovski, 59037 Lille, France
2
Université Paris-Saclay (Université Paris-Sud), Inserm, Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Le Kremlin-Bicêtre, France
9
3
CHU de Toulouse, Hôpital Larrey, 24 Chemin de Pouvourville, TSA 30030, 31059 Toulouse Cedex 9, Fra
Data Loading...
