Pharmacological treatment of acromegaly: its place in the overall therapeutic approach

New therapeutic agents for acromegaly

The currently available somatostatin receptor ligands (SRLs) and growth hormone (GH) antagonists are used to control levels of GH and insulin-like growth factor 1 (IGF-1) in patients with acromegaly. However, these therapies are limited by wide variations in efficacy, associated adverse effects and the need for frequent injections. A phase III trial of oral octreotide capsules demonstrated that this treatment can safely sustain suppressed levels of GH and IGF-1 and reduce the severity of symptoms in patients with acromegaly previously controlled by injectable SRL therapy, with the added benefit of no injection-site reactions. Phase I and phase II trials of the pan-selective SRL DG3173, the liquid crystal octreotide depot CAM2029 and an antisense oligonucleotide directed against the GH receptor have shown that these agents can be used to achieve biochemical suppression in acromegaly and have favourable safety profiles. This Review outlines the need for new therapeutic agents for patients with acromegaly, reviews clinical trial data of investigational agents and considers how these therapies might best be integrated into clinical practice.

Pharmacotherapy for acromegaly: future role for pasireotide?

Somatostatin receptor ligands (octreotide and lanreotide) are currently first-line pharmacotherapy for patients with acromegaly in whom surgery fails to control the disease or cannot be considered. The efficacy of a new pan somatostatin receptor ligand, pasireotide, has been investigated as a potential treatment of acromegaly. Several clinical trials showed disease-remission with pasireotide in one-third of patients and some octreotide-resistant patients were responsive to pasireotide. Pasireotide can likely be used for patients with suboptimal response or resistance to treatment with the approved maximal doses of octreotide long-acting release (LAR) or lanreotide Autogel; however, the development or exacerbation of diabetes mellitus is of concern.