Combined treatment of somatostatin analogues with pegvisomant in acromegaly
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MINI REVIEW
Combined treatment of somatostatin analogues with pegvisomant in acromegaly S. E. Franck1 • A. Muhammad1 • A. J. van der Lely1 • S. J. C. M. M. Neggers1
Received: 1 September 2015 / Accepted: 17 November 2015 / Published online: 10 December 2015 Ó The Author(s) 2015. This article is published with open access at Springerlink.com
Abstract Treatment of acromegaly with monotherapy long-acting somatostatin analogues (LA-SSA) as primary treatment or after neurosurgery can only achieve complete normalization of insulin-like growth factor I (IGF-I) in roughly 40 % of patients. Recently, one of the acromegaly consensus groups has recommended switching to combined treatment of LA-SSA and pegvisomant (PEGV) in patients with partial response to LA-SSAs. This combination of LA-SSA and PEGV, a growth hormone receptor antagonist, can normalize IGF-I levels in virtually all patients, requiring that the adequate dose of PEGV is used. The required PEGV dose varies significantly between individual acromegaly patients. One of the advantages of the combination therapy is that tumor size control or even tumor shrinkage can be observed in a vast majority of patients. The main side effects of the combination treatment are gastrointestinal symptoms, lipohypertrophy and transient elevated liver transaminases. In this review we provide an overview of the efficacy and safety of the combined treatment of LA-SSAs with PEGV. Keywords Acromegaly Somatostatin analogues Growth hormone receptor antagonist Pegvisomant Growth hormone Insulin-like growth factor I
S.E. Franck and A. Muhammad contributed equally and share first authorship. & S. E. Franck [email protected] 1
Department of Internal Medicine, Endocrinology Section, Pituitary Center Rotterdam, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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Abbreviations GH Growth hormone IGF-I Insulin-like growth factor I LA-SSA Long-acting somatostatin analogue GHR Growth hormone receptor PEGV Pegvisomant
Introduction Acromegaly is a rare disease almost exclusively caused by a growth hormone (GH) secreting pituitary adenoma. This hypersecretion of GH and the associated elevated IGF-I levels result in increased morbidity and mortality [1]. Surgery is in general the first treatment modality, but is not always successful, as the majority of the patients have a macroadenoma [1]. The reported cure rates of transsphenoidal surgery vary widely, mainly depending on tumor size and invasiveness and the experience of the neurosurgeon [2]. Surgery of microadenomas (\1 cm in diameter) has an average cure rate of 78 %, whereas with macroadenomas (C1 cm in diameter) the average cure rate B50 % [2]. However, these previous results were obtained 10 years ago. More recent data from daily practice were shown in a study with data gathered from the UK National Acromegaly Registry. This study reported cure rates between 20 and 40 % [3]. LA-SSAs are currently used as pre-surgical treatment, adjuvant treatment and as primary medical treatment. Multiple studie
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