Combined treatment for acromegaly with long-acting somatostatin analogs and pegvisomant: Long-term safety for up to 4.5 years (median 2.2 years) of follow-up in 86 patients

S. J.C.M.M. Neggers, W. W. de Herder, J. A.M.J.L. Janssen, R. A. Feelders, A. J. van der Lely

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109 Citaten (Scopus)

Samenvatting

Background: We previously reported on the efficacy, safety, and quality of life (QoL) of long-acting somatostatin analogs (SSA) and (twice) weekly pegvisomant (PEG-V) in acromegaly and improvement after the addition of PEG-V to long-acting SSA. Objective: To assess the long-term safety in a larger group of acromegalic patients over a larger period of time: 29.2 (1.2-57.4) months (mean (range)). Design: Pegvisomant was added to SSA monotherapy in 86 subjects (37 females), to normalize serum IGF1 concentrations (n=63) or to increase the QoL. The median dosage was 60.0 (20-200) mg weekly. Results: After a mean treatment period of 29.2 months, 23 patients showed dose-independent PEG-V related transient liver enzyme elevations (TLEE). TLEE occurred only once during the continuation of combination therapy, but discontinuation and re-challenge induced a second episode of TLEE. Ten of these patients with TLEE also suffered from diabetes mellitus (DM). In our present series, DM had a 2.28 odds ratio (CI 1.16-9.22; p=0.03) higher risk for developing TLEE. During the combined therapy, a clinical significant decrease in tumor size by more than 20% was observed in 14 patients. Two of these patients were previously treated by pituitary surgery, 1 with additional radiotherapy and all other patients received primary medical treatment. Conclusion: Long-term combined treatment with SSA and twice weekly PEG-V up to more than 4 years seems to be safe. Patients with both acromegaly and DM have a 2.28 higher risk of developing TLEE. Clinical significant tumor shrinkage was observed in 14 patients during combined treatment.

Originele taal-2Engels
Pagina's (van-tot)529-533
Aantal pagina's5
TijdschriftEuropean Journal of Endocrinology
Volume160
Nummer van het tijdschrift4
DOI's
StatusGepubliceerd - 2009
Extern gepubliceerdJa

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