Effects of long-term combined treatment with somatostatin analogues and pegvisomant on cardiac structure and performance in acromegaly

Auriemma, Renata S.; Grasso, Ludovica F. S.; Galdiero, Mariano; Galderisi, Maurizio; Pivonello, Claudia; Simeoli, Chiara; Martino, Maria Cristina De; Ferrigno, Rosario; Negri, Mariarosaria; Angelis, Cristina de; Pivonello, Rosario; Colao, Annamaria

doi:10.1007/s12020-016-0995-5

Cited by 43 publications

(40 citation statements)

References 80 publications

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“…We selected 24 studies after title and abstract screening. Finally, nine studies [2,[21][22][23][24][25][26][27][28] were included in the meta-analysis after full text reading. Fig.1 shows the flowchart of study selection.…”

Section: Literature Screenmentioning

confidence: 99%

“…Among the nine studies included in this meta-analysis, two were RCT [21,23], one was double-blind, placebo-controlled, crossover study [22], one was longitudinal comparative study [24], one was follow-up comparative study [25] and the remaining were non-comparative studies [2,[26][27][28].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Four studies, 150 patients, were included in this analysis [2,21,26,27]. In these studies, all patients had IGF-1 levels that were greater than the upper limit of normal (ULN) despite SAs monotherapy.…”

Section: Igf-1 Normalizationmentioning

confidence: 99%

“…Meta-analysis of 4 studies, 111 patients, [2,[26][27][28] showed that the combination therapy did not significantly affect FPG (ES: 0.011 mmol*L -1 ; 95% CI: −0.374 to 0.397 mmol*L -1 ; I 2 =83.7%; P=0.954) (Fig.3). Four studies [2,[26][27][28], 111 patients, were included in the analysis of FPI (ES: −21.487 pmol*L -1 ; 95% CI: −35.713 to -7.260 pmol*L -1 ; P=0.003), with high heterogeneity (I 2 =76.0%), revealing significant change (Fig.4). Five papers, 160 patients, reported HbA1c levels before and after treatment [2,21,[25][26][27].…”

Section: Glucose Metabolismmentioning

confidence: 99%

“…Four studies [2,[26][27][28], 111 patients, were included in the analysis of FPI (ES: −21.487 pmol*L -1 ; 95% CI: −35.713 to -7.260 pmol*L -1 ; P=0.003), with high heterogeneity (I 2 =76.0%), revealing significant change (Fig.4). Five papers, 160 patients, reported HbA1c levels before and after treatment [2,21,[25][26][27]. A slight decrease was found (ES: −0.074%; 95% CI: −0.166% to 0.315%; P=0.544), accompanied by high heterogeneity (I 2 =92.2%) ( Fig.5).…”

Section: Glucose Metabolismmentioning

confidence: 99%

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Combined therapy of somatostatin analogues with pegvisomant for the treatment of acromegaly: a meta-analysis of prospective studies

Luo

Yang

et al. 2020

Preprint

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Background: Acromegaly is a rare, chronic and severe disease. Drug therapy including somatostatin analogues, dopamine receptor agonists and growth hormone receptor antagonists are commonly used to treat patients who do not respond to surgery. The use of combination therapy with PEG and SAs has become more common over the last decade. We performed this study to accurately evaluate the effect of combination therapy of somatostatin analogues (SAs) with pegvisomant (PEG) on acromegalic patients. Methods: PubMed, EMBASE, The Cochrane Library, ClinicalTrials.gov, Scopus, Web of Science, Chinese Biomedical Literature Database and Trip database were searched for relevant studies. Prospective clinical trials treating acromegaly with the co-administration of SAs and PEG were included. We performed a meta-analysis by using Stata 12.1 . Sensitivity analysis was conducted to explore heterogeneity. Results : Eight studies were included in this meta-analysis. The overall rate of serum insulin-like growth factor 1 (IGF-1) normalization was 66% (95% CI: 52%–78%; I 2 =62.59%). The combination therapy did not significantly change patients’ fasting plasma glucose (ES: 0.011 mmol*L -1 ; 95% CI: −0.374 to 0.397 mmol*L -1 ; P=0.954) or glycosylated haemoglobin (ES: -0.074%; 95% CI: −0.166% to 0.315%; P=0.544) while decreasing the fasting plasma insulin (ES: −21.487 pmol*L-1; 95% CI: −35.713 to -7.260 pmol*L-1; P=0.003). Elevation of liver enzyme levels was found in 14% (95% CI: 8% to 21%) of the patients. There was no significant difference for serious adverse events and treatment discontinuation due to adverse event between SAs monotherapy group and combination therapy group. Conclusions: Combined therapy of SAs and PEG effectively normalized IGF-1 levels in most of the patients whose IGF-1 level was greater than the upper limit of normal after high dose SAs monotherapy. The therapy also decreased significantly FPI levels with a neutral effect on glucose parameters in acromegaly patients. Moreover, elevated liver enzyme levels were observed in a small number of patients, which suggests a need for liver function monitoring. Trial registration We have our protocol registered in PROSPERO. (Registration number: CRD42019115549)

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