Long‐term treatment with pegvisomant for acromegaly: a 10‐year experience

Ramos-Leví, Ana M.; Bernabéu, Ignacio; Álvarez-Escolá, Cristina; Aller, Javier; Lucas, T.; Miguel, Paz de; Rodríguez-Cañete, Leticia; Sampedro‐Núñez, Miguel; Halperín, Irene; Puig-Domingo, Manel; Marazuela, Mónica

doi:10.1111/cen.12993

Cited by 11 publications

(12 citation statements)

References 36 publications

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“…7 Another study reviewed the efficacy of pegvisomant as a monotherapy for acromegaly over a 10-year period, and showed 6 of 64 (9.4%) cases with tumor growth. 123 Pegvisomant has also been evaluated in a combination therapy with SRL, particularly with respect to normalizing the IGF1 concentration in acromegalic patients who have failed SRL monotherapy. The outcome of a 42-week study of active acromegalic patients demonstrated that the combined therapy was effective in normalizing the levels of IGF1 and that there was no indication of tumor growth.…”

Section: Strategies That Target Ghr Signalingmentioning

confidence: 99%

Targeting growth hormone function: strategies and therapeutic applications

Flanagan

Langley

et al. 2019

Sig Transduct Target Ther

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Human growth hormone (GH) is a classical pituitary endocrine hormone that is essential for normal postnatal growth and has pleiotropic effects across multiple physiological systems. GH is also expressed in extrapituitary tissues and has localized autocrine/paracrine effects at these sites. In adults, hypersecretion of GH causes acromegaly, and strategies that block the release of GH or that inhibit GH receptor (GHR) activation are the primary forms of medical therapy for this disease. Overproduction of GH has also been linked to cancer and the microvascular complications that are associated with diabetes. However, studies to investigate the therapeutic potential of GHR antagonism in these diseases have been limited, most likely due to difficulty in accessing therapeutic tools to study the pharmacology of the receptor in vivo. This review will discuss current and emerging strategies for antagonizing GH function and the potential disease indications.

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Section: Strategies That Target Ghr Signalingmentioning

confidence: 99%

Targeting growth hormone function: strategies and therapeutic applications

Flanagan

Langley

et al. 2019

Sig Transduct Target Ther

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“…In fact, two large comprehensive reviews exploring this issue concluded that control of GH and IGF-I excess could halt the progression of cardiovascular abnormalities, as well as the observed morphological and functional cardiac alterations (58, 89). Additionally, concomitant cardiovascular risk factors, such as hypertension, dyslipidemia, diabetes mellitus, and sleep apnea syndrome, could also improve (28, 92–94). Epidemiological data have confirmed these findings, and disease control in acromegalic patients has been found to be one of the most important determinants of patients' outcome (5), and consistently associated to a reduction in cardiovascular mortality (1, 2, 55).…”

Section: How Does Disease Control Affect Cardiovascular Comorbiditiesmentioning

confidence: 99%

“…In fact, treatment of acromegalic patients with pegvisomant improved left ventricular mass, systolic and diastolic function and blood pressure, reduced the prevalence of conduction disturbances, and even decreased the Framingham risk score after 12 months of treatment in the German Pegvisomant Observational Study (121, 123–125). Furthermore, the reduction in levels of glucose, insulin, and HOMA index may be relevant for its overall beneficial role (94, 119, 120), because of the collateral effect on glucose homeostasis.…”

Section: How Does Disease Control Affect Cardiovascular Comorbiditiesmentioning

confidence: 99%

Bringing Cardiovascular Comorbidities in Acromegaly to an Update. How Should We Diagnose and Manage Them?

Ramos-Leví

Marazuela

2019

Front. Endocrinol.

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Patients with acromegaly frequently develop cardiovascular comorbidities, which significantly affect their morbidity and contribute to an increased all-cause mortality. In this regard, the most frequent complications that these patients may encounter include hypertension, cardiomyopathy, heart valve disease, arrhythmias, atherosclerosis, and coronary artery disease. The specific underlying mechanisms involved in the pathophysiology of these comorbidities are not always fully understood, but uncontrolled GH/IGF-I excess, age, prolonged disease duration, and coexistence of other cardio-vascular risk factors have been identified as significant influencing predisposing factors. It is important that clinicians bear in mind the potential development of cardiovascular comorbidities in acromegalic patients, in order to promptly tackle them, and avoid the progression of cardiac abnormalities. In many cases, this approach may be performed using straightforward screening tools, which will guide us for further diagnosis and management of cardiovascular complications. This article focuses on those cardiovascular comorbidities that are most frequently encountered in acromegalic patients, describes their pathophysiology, and suggests some recommendations for an early and optimal diagnosis, management and treatment.

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“…If the adenoma grows, a somatostatin analogue can be used [34]. Pegvisomant is administered subcutaneously on a daily basis at 10-30 mg as monotherapy or in combination with a somatostatin analogue [32,34,35].…”

Section: Continue Therapy Control Development Of Disease Complicationsmentioning

confidence: 99%

“…Pegwisomant nie wpływa korzystnie na wielkość guza przysadki i z uwagi na ryzyko powiększania się gruczolaka w czasie leczenia konieczna jest kontrola jego objętości za pomocą MR. W przypadku powiększenia się gruczolaka można dodatkowo zastosować analog somatostatyny [34]. Pegwisomant podaje się codzienne, w dawkach 10-30 mg podskórnie w monoterapii lub łącznie z analogiem somatostatyny [32,34,35].…”

Section: Wytyczneunclassified

Diagnostics and treatment of acromegaly — updated recommendations of the Polish Society of Endocrinology

Bolanowski

Ruchała

Zgliczyński

et al. 2019

Endokrynologia Polska

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Acromegaly is a rare disease caused by excessive production of growth hormone (GH), typically by a pituitary tumour. The diagnosis is usually delayed, and patients frequently develop various complications that cause premature mortality. In patients with hypertension, heart failure, diabetes, and arthropathies that are not age-specific, attention should be paid to signs of acromegaly. Insulin-like growth factor 1 (IGF-1) assay should be used as a screening test whenever acromegaly is suspected. Further diagnostic investigations and treatment should be carried out at specialist centres. First-line treatment involves selective excision of pituitary adenoma using transsphenoidal access. Patients with chances of cure with surgical removal of the pituitary tumour should be referred to centres that have experience in this type of procedure, following pharmacological preparation. Other patients, as well as patients after failed neurosurgical treatment, should first receive chronic treatment with first-generation somatostatin analogues. For second-line treatment, pasireotide, pegvisomant, cabergoline, or combinations thereof should be considered. In every case, acromegaly sequelae require life-long monitoring and active treatment. Current recommendations, being an updated version of the recommendations published in Endokrynologia Polska in 2014, which take into account the Polish situation, should prove useful in the management of patients with acromegaly. (Endokrynol Pol 2019; 70 (1): 2-10)

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Long‐term treatment with pegvisomant for acromegaly: a 10‐year experience

Abstract: We reassure the efficacy and safety of long-term PEG. An escape phenomenon may occur, but it can be overcome by adjusting therapy.

Cited by 11 publications

References 36 publications

Targeting growth hormone function: strategies and therapeutic applications

Targeting growth hormone function: strategies and therapeutic applications

Bringing Cardiovascular Comorbidities in Acromegaly to an Update. How Should We Diagnose and Manage Them?

Diagnostics and treatment of acromegaly — updated recommendations of the Polish Society of Endocrinology

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