How to improve effectiveness of pegvisomant treatment in acromegalic patients

Ragonese, M.; Grottoli, Silvia; Maffei, Pietro; Alibrandi, Angela; Ambrosio, Maria Rosaria; Arnaldi, Giorgio; Bianchi, Antonio; Puglisi, Soraya; Zatelli, Maria Chiara; Marinis, Laura De; Ghigo, Ezio; Giustina, Andrea; Maffezzoni, Filippo; Martini, Chiara; Trementino, Laura; Cannavò, Salvatore

doi:10.1007/s40618-017-0773-0

Cited by 20 publications

(18 citation statements)

References 34 publications

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“…Of note, a higher mean dose of pegvisomant was needed in patients with DM (18.2 vs 15.3 mg/day), who also had a higher mean BMI compared with non-diabetic patients [81]. Results of a multicenter study of 87 patients [83] similarly showed that obese patients required a higher pegvisomant dose and a more rapid up-titration to achieve biochemical control. These results support an earlier ACROSTUDY report that found that the 56 patients who needed > 30 mg/ day pegvisomant to achieve IGF-I normalization were younger, had higher BMI, and were also more likely to have DM, OSA, and hypertension [84].…”

Section: Pegvisomantmentioning

confidence: 98%

A Pituitary Society update to acromegaly management guidelines

et al. 2020

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Guidelines and consensus statements ensure that physicians managing acromegaly patients have access to current information on evidence-based treatments to optimize outcomes. Given significant novel recent advances in understanding acromegaly natural history and individualized therapies, the Pituitary Society invited acromegaly experts to critically review the current literature in the context of Endocrine Society guidelines and Acromegaly Consensus Group statements. This update focuses on how recent key advances affect treatment decision-making and outcomes, and also highlights the likely role of recently FDA-approved therapies as well as novel combination therapies within the treatment armamentarium.

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Section: Pegvisomantmentioning

confidence: 98%

A Pituitary Society update to acromegaly management guidelines

et al. 2020

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“…This difference is probably primarily attributable to differences in doses, as patients in clinical practice are less likely to be uptitrated to the maximum dose despite higher efficacy rates being seen at higher doses 77 (VLQ). Pegvisomant is approved for use at doses ranging from 10 mg per day to 30 mg per day, and we recommend that the daily dose should be increased to the recommended highest dose as needed (SR).…”

Section: Gh Receptor Antagonistmentioning

confidence: 99%

A Consensus Statement on acromegaly therapeutic outcomes

et al. 2018

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“…99 However, a number of clinical studies have shown that younger, female patients and subjects with higher BMI and IGF-1 values at diagnosis need more PEG to reach biochemical control, and seem to be more resistant to treatment. [100][101][102] The recent Consensus on acromegaly treatment recommends the use of PEG at a dosage of 10-30 mg per day, titrated up to the highest tolerated dose (max 240 mg/week).…”

Section: Patient Not Controlled Tumor Concern: Switch To Pasireotidementioning

confidence: 99%

<p>Octreotide-Resistant Acromegaly: Challenges and Solutions</p>

Corica¹,

Ceraudo²,

Campana³

et al. 2020

TCRM

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Acromegaly is a rare and severe disease caused by an increased and autonomous secretion of growth hormone (GH), thus resulting in high circulating levels of insulin-like growth factor 1 (IGF-1). Comorbidities and mortality rate are closely related to the disease duration. However, in most cases achieving biochemical control means reducing or even normalizing mortality and restoring normal life expectancy. Current treatment for acromegaly includes neurosurgery, radiotherapy and medical therapy. Transsphenoidal surgery often represents the recommended first-line treatment. First-generation somatostatin receptor ligands (SRLs) are the drug of choice in patients with persistent disease after surgery and are suggested as first-line treatment for those ineligible for surgery. However, only about half of patients treated with octreotide (or lanreotide) achieve biochemical control. Other available drugs approved for clinical use are the second-generation SRL pasireotide, the dopamine agonist cabergoline, and the GH-receptor antagonist pegvisomant. In the present paper, we revised the current literature about the management of acromegaly, aiming to highlight the most relevant and recent therapeutic strategies proposed for patients resistant to first-line medical therapy. Furthermore, we discussed the potential molecular mechanisms involved in the variable response to first-generation SRLs. Due to the availability of different medical therapies, the choice for the most appropriate drug can be currently based also on the peculiar clinical characteristics of each patient.

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How to improve effectiveness of pegvisomant treatment in acromegalic patients

Abstract: PEGV effectiveness improves when up titration is appropriate. Higher PEGV doses at start and a more rapid up-titration are necessary in patients with obesity and/or IGF-1 > 2.7 × ULN.

Cited by 20 publications

References 34 publications

A Pituitary Society update to acromegaly management guidelines

A Pituitary Society update to acromegaly management guidelines

A Consensus Statement on acromegaly therapeutic outcomes

<p>Octreotide-Resistant Acromegaly: Challenges and Solutions</p>

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