The efficacy of pegvisomant in patients with acromegaly resistant to 1st generation somatostatin analogues
E.V. Pronin, T.M. Alekseeva, M.B. Antsiferov
Endocrinological Dispensary of the Moscow Healthcare Department, Moscow, Russia
Background. Due to the emergence of multidirectional drugs, doctors have the opportunity to solve the problem of resistance to 1st generation somatostatin analogues (SA1) by the administration of second-line drugs or switching to other dosage forms.
Objective. Prospective analysis of the results of the use of pegvisomant (PEG) in the treatment of patients resistant to secondary therapy with high-dose SA1.
Methods. The article presents the results of adding PEG to the treatment of 43 patients (19 men, 24 women) who had previously under-gone non-radical transsphenoidal adenomectomy and were resistant to long-term treatment with maximum doses of SA1. All patients were additionally prescribed PEG (Somavert) at a starting dose of 10-15 mg (loading dose - 40-60 mg). During treatment, dynamic monitoring of the insulin-like growth factor 1 (IGF-1) level, IGF-1 index (II), hepatic transaminases, and carbohydrate metabolism was carried out. Biochemical remission of acromegaly was recorded at an II value of 4,1. Duration of treatment ranged from 3 to 21 months (30 patients >6 months).
Results. During treatment with PEG, 57% of patients in the resistant group achieved a stable biochemical remission, which made it pos-sible to reduce the dose, and in some cases stop taking SA1. A direct correlation between the drug titration rate and the initial II level, body mass index and the glycosylated hemoglobin level was revealed. Taking the drug was not accompanied by continued growth of the residual tumor and the development of serious side effects (except for the 1st case). Two clinical cases of the use of PEG are described. Conclusion. Adding a 2nd-line drug, PEG, to the treatment of patients with poorly controlled acromegaly against the background of high-dose SA1 monotherapy provides sufficient biochemical and tumor control with minimal side effects. The use of differentiated treatment regimens will increase the effectiveness of pharmacotherapy and reduce the total therapeutic dose of drugs.
About the Autors
Corresponding author: Evgeny V. Pronin, Endocrinologist, Endocrinological Dispensary of the Moscow Healthcare Department, Moscow, Russia; email@example.com