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Moustaki M, Paschou SA, Xekouki P, Kotsa K, Peppa M, Psaltopoulou T, Kalantaridou S, Vryonidou A. Secondary diabetes mellitus in acromegaly. Endocrine 2023; 81:1-15. [PMID: 36882643 PMCID: PMC10239382 DOI: 10.1007/s12020-023-03339-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/21/2023] [Indexed: 03/09/2023]
Abstract
Secondary diabetes mellitus (DM) is a common complication of acromegaly, encountered in up to 55% of cases. Vice versa, the prevalence of acromegaly is markedly higher in cohorts of patients with type 2 DM (T2DM). The presence of secondary DM depends primarily on acromegaly status and is associated with increased cardiovascular morbidity, malignancy rate and overall mortality. The principal pathophysiologic mechanism is increased insulin resistance due to excessive lipolysis and altered fat distribution, reflected at the presence of intermuscular fat and attenuated, dysfunctional adipose tissue. Insulin resistance is ascribed to the direct, diabetogenic effects of growth hormone (GH), which prevail over the insulin-sensitizing effects of insulin-like growth factor 1 (IGF-1), probably due to higher glucometabolic potency of GH, IGF-1 resistance, or both. Inversely, GH and IGF-1 act synergistically in increasing insulin secretion. Hyperinsulinemia in portal vein leads to enhanced responsiveness of liver GH receptors and IGF-1 production, pointing towards a mutually amplifying loop between GH-IGF-1 axis and insulin. Secondary DM occurs upon beta cell exhaustion, principally due to gluco-lipo-toxicity. Somatostatin analogues inhibit insulin secretion; especially pasireotide (PASI) impairs glycaemic profile in up to 75% of cases, establishing a separate pathophysiologic entity, PASI-induced DM. In contrast, pegvisomant and dopamine agonizts improve insulin sensitivity. In turn, metformin, pioglitazone and sodium-glucose transporters 2 inhibitors might be disease-modifying by counteracting hyperinsulinemia or acting pleiotropically. Large, prospective cohort studies are needed to validate the above notions and define optimal DM management in acromegaly.
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Affiliation(s)
- Melpomeni Moustaki
- Department of Endocrinology and Diabetes Center, Hellenic Red Cross Hospital, Athens, Greece
| | - Stavroula A Paschou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Paraskevi Xekouki
- Department of Endocrinology and Diabetes, University General Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Greece
| | - Kalliopi Kotsa
- Endocrine Unit and Diabetes Center, First Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Melpomeni Peppa
- Endocrine Unit and Diabetes Center, Second Department of Internal Medicine, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Psaltopoulou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Kalantaridou
- 3rd Department of Obstetrics and Gynecology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Andromachi Vryonidou
- Department of Endocrinology and Diabetes Center, Hellenic Red Cross Hospital, Athens, Greece
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Chiloiro S, Costa D, Lauretta R, Mercuri V, Sbardella E, Samperi I, Appetecchia M, Bianchi A, Giampietro A, Gargiulo P, Isidori AM, Poggi M, Pontecorvi A, De Marinis L. Partial response to first generation SSA guides the choice and predict the outcome of second line therapy in acromegaly. Endocrine 2022; 78:343-353. [PMID: 35986839 PMCID: PMC9584996 DOI: 10.1007/s12020-022-03158-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Treatment of acromegaly resistant to first generation somatostatin analogues (first gen-SSA) is often difficult. We aimed to investigate the role of partial response and resistance to first gen-SSA in the choice of second line treatments and their outcomes. PATIENTS AND METHODS A retrospective and multicenter study was conducted on 100 SSA-resistant acromegaly patients and treated with Pasireotide Lar (Pasi-Lar), Peg-V in monotherapy (m-Peg-V) or in combination with first gen-SSA (c-Peg-V). RESULTS Thirty-three patients (33%) were treated with m-Peg-V, 36 (36%) with c-Peg-V and 31 with Pasi-Lar (31%). According to logistic regression, m-Peg-V was chosen in older patients (p = 0.01) and with not-invasive adenomas (p = 0.009), c-Peg-V therapy in younger patients (p = 0.001), with invasive adenomas (p = 0.02), Pasi-Lar was in invasive adenomas (p = 0.01) and in patients partially responsive to first-gen SSA (p = 0.01). At the last follow-up, 68 patients (68%) reached the acromegaly control: 22 with m-Peg-V (32.4%), 23 with c-Peg-V (33.8%) and 23 with Pasi-Lar (33.8%). Patients non-responsive to c-Peg-V had higher IGF-I levels (median 3.2 x ULN, IQR: 1.6, p < 0.001) and required higher Peg-V dosage (median 30 mg/daily IQR: 10, p = 0.002) as compared to responsive patients (median IGF-I x ULN: 2.1 IQR: 1.4; median Peg-V dosage 20 mg/daily IQR: 10). All patients responsive to Pasi-Lar were partially responsive to first gen-SSAs (p = 0.02). CONCLUSION Our data showed that c-Peg-V and Pasi-Lar are chosen for the treatment of invasive tumors. The partial response to first gen-SSA seems to be the main determinant for the choice of Pasi-Lar and positively predicts the treatment outcome.
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Affiliation(s)
- Sabrina Chiloiro
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Roma, Italy
- UOC Endocrinology and Diabetology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Denise Costa
- Department of Experimental Medicine, Endocrinology-Pituitary Disease, "Sapienza" University of Rome, Roma, Italy
| | - Rosa Lauretta
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - Valeria Mercuri
- Department of Experimental Medicine, Endocrinology-Pituitary Disease, "Sapienza" University of Rome, Roma, Italy
| | - Emilia Sbardella
- Department of Experimental Medicine, Endocrinology-Pituitary Disease, "Sapienza" University of Rome, Roma, Italy
| | - Irene Samperi
- Endocrine-Metabolic Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Marialuisa Appetecchia
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - Antonio Bianchi
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Roma, Italy
- UOC Endocrinology and Diabetology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Antonella Giampietro
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Roma, Italy
- UOC Endocrinology and Diabetology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Patrizia Gargiulo
- Department of Experimental Medicine, Endocrinology-Pituitary Disease, "Sapienza" University of Rome, Roma, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Endocrinology-Pituitary Disease, "Sapienza" University of Rome, Roma, Italy
| | - Maurizio Poggi
- Endocrine-Metabolic Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Alfredo Pontecorvi
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Roma, Italy
- UOC Endocrinology and Diabetology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Laura De Marinis
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Roma, Italy.
- UOC Endocrinology and Diabetology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy.
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Marazuela M, Blanco C, Bernabeu I, Menendez E, Villar R, Paja M, Sampedro-Nuñez M, Samaniego ML, Díaz-Muñoz M, Sánchez-Cenizo L. Acromegaly disease activity according to ACRODAT®, a cross-sectional study in Spain: ACROVAL study. Endocrine 2022; 75:525-536. [PMID: 34668173 PMCID: PMC8816757 DOI: 10.1007/s12020-021-02900-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate disease activity status using the Acromegaly Disease Activity Tool (ACRODAT®) in a cohort of Spanish acromegaly patients, to assess the relationship between the level of disease activity according to both ACRODAT® and the physicians' clinical evaluation, and to study the potential discrepancies in the perception of symptoms between physicians and patients. DESIGN Multicenter, observational, descriptive and cross-sectional study. METHODS Disease activity was assessed in adult patients with acromegaly under pharmacological treatment during at least 6 months using ACRODAT®. RESULTS According to ACRODAT®, 48.2%, 31.8% and 20.0% of a total of 111 patients were classified as having a stable disease (S), mild disease activity (M-DA) and significant disease activity (S-DA) respectively. ACRODAT® classification of disease activity significantly correlated with physicians' opinion, with a moderate inter-rater agreement and a specificity of 92.45% (PPV = 86.21%). No correlation was found between IGF-I levels and severity of symptoms or quality of life (QoL). A decision to take clinical action was significantly more frequent in S-DA and M-DA patients than S patients but no action was taken on 5 (22.7%) and 27 (77.1%) S-DA and M-DA patients, respectively CONCLUSIONS: ACRODAT® detected disease activity in 51.8% of patients. Interestingly, although M-DA and S-DA patients were likely to be in the process of being controlled, action was not always taken on these patients. ACRODAT® is a validated and highly specific tool that may be useful to routinely monitor acromegaly and to identify patients with non-obvious disease activity by incorporating "patient-centred" parameters like symptoms and QoL to the clinical evaluation of acromegaly.
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Affiliation(s)
- Mónica Marazuela
- Hospital Universitario de La Princesa, Madrid, Universidad Autónoma de Madrid, Madrid, Spain
| | - Concepción Blanco
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Ignacio Bernabeu
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | - Edelmiro Menendez
- Hospital Universitario Central de Asturias (HUCA), Instituto de investigación del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | - Rocío Villar
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | - Miguel Paja
- Hospital Universitario de Basurto, Bilbao, Vizcaya, Spain
| | - Miguel Sampedro-Nuñez
- Hospital Universitario de La Princesa, Madrid, Universidad Autónoma de Madrid, Madrid, Spain
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Fleseriu M, Führer-Sakel D, van der Lely AJ, De Marinis L, Brue T, van der Lans-Bussemaker J, Hey-Hadavi J, Camacho-Hubner C, Wajnrajch MP, Valluri SR, Palladino AA, Gomez R, Salvatori R. More than a decade of real-world experience of pegvisomant for acromegaly: ACROSTUDY. Eur J Endocrinol 2021; 185:525-538. [PMID: 34342594 PMCID: PMC8428076 DOI: 10.1530/eje-21-0239] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report the final long-term safety and efficacy analyses of patients with acromegaly treated with pegvisomant from the ACROSTUDY. DESIGN Global (15 countries), multicentre, non-interventional study (2004-2017). METHODS The complete ACROSTUDY cohort comprised patients with acromegaly, who were being treated with pegvisomant (PEGV) prior to the study or at enrolment. The main endpoints were long-term safety (comorbidities, adverse events (AEs), pituitary tumour volumes, liver tests) and efficacy (IGF1 changes). RESULTS Patients (n = 2221) were treated with PEGV for a median of 9.3 years (range, 0-20.8 years) and followed up for a median of 7.4 years (range, 0-13.9 years). Before PEGV, 96.3% had received other acromegaly treatments (surgery/radiotherapy/medications). Before PEGV treatment, 87.2% of patients reported comorbidities. During ACROSTUDY, 5567 AEs were reported in 56.5% of patients and of these 613 were considered treatment-related (in 16.5% of patients) and led to drug withdrawal in 1.3%. Pituitary imaging showed a tumour size increase in 7.1% of patients; the majority (71.1%) reported no changes. Abnormal AST or ALT liver tests occurred in 3.2% of patients. IGF1 normalization rate improved over time, increasing from 11.4% at PEGV start to 53.7% at year 1, and reaching 75.4% at year 10 with the use of ≥30 mg PEGV/day in an increasing proportion of patients. CONCLUSION This comprehensive review of the complete cohort in ACROSTUDY confirmed the overall favourable benefit-to-risk profile and high efficacy of PEGV as mono- and combination therapy in patients with an aggressive course/uncontrolled/active acromegaly requiring long-term medical therapy for control.
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Affiliation(s)
- Maria Fleseriu
- Pituitary CenterDivision of Endocrinology, Diabetes, & Clinical Nutrition, Department of Medicine
- Pituitary Center, Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
- Correspondence should be addressed to M Fleseriu Email
| | - Dagmar Führer-Sakel
- Department of Endocrinology Diabetology and Metabolism, Endocrine Tumour Center at West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Aart J van der Lely
- Division of Endocrinology, Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Laura De Marinis
- Pituitary Unit, Department of Endocrinology, Fondazione A Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Thierry Brue
- Assistance Publique-Hôpitaux de Marseille, Hopital de la Conception, and Aix-Marseille Université, Marseille Medical Genetics, Marseille, France
| | | | | | | | - Michael P Wajnrajch
- Pfizer, New York, New York, USA
- Division of Pediatric Endocrinology, Department of Pediatrics, New York University Langone Medical Center, New York, New York, USA
| | | | | | | | - Roberto Salvatori
- Division of Endocrinology and Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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García-Casares N, Fernández-Andújar M, González-Molero I, Maraver-Selfa S, Gutiérrez-Bedmar M, Ramos-Rodriguez JR, Alfaro-Rubio F, Roé-Vellvé N, Garcia-Garcia I, García-Arnés JA. Cognitive Functioning and Cortical Brain Thickness in Acromegaly Patients: A Pilot study. Arch Clin Neuropsychol 2021; 36:780-790. [PMID: 33200172 DOI: 10.1093/arclin/acaa106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/12/2020] [Accepted: 10/01/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Cognitive effects in acromegaly patients are poorly understood and the mechanisms involved are still unclear. The aim of this study was to evaluate the cognitive function, depression, and quality of life of acromegaly patients treated with pegvisomant versus somatostatin analogues (SRLs) and to analyze the effect of the different treatments on cognition and possible structural brain changes. METHODS This cross-sectional study involved 23 acromegaly patients divided into two groups according to treatment modality: One group of 9 patients treated with pegvisomant and another group of 14 patients treated with SRLs. All participants underwent blood analysis, neuropsychological tests, depression tests, quality of life assessment, and 3-Tesla magnetic resonance imaging. RESULTS We found no significant differences between groups in the neuropsychological tests, depression or quality of life; nor in the whole-brain cortical thickness. In the SRL group, the volume of the thalamus correlated positively with executive function, a correlation not found in the pegvisomant group. In addition, the pegvisomant group had significantly higher levels of insulin than the SRL group. CONCLUSIONS In conclusion, in this pilot study, the type of pharmacological treatment in patients with acromegaly and good glycemic control did not influence the cognitive function and cortical brain thickness. However, pegvisomant could play a neuroprotective role on the thalamus that will have to be demonstrated with larger samples in future studies.
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Affiliation(s)
- Natalia García-Casares
- Department of Medicine, Faculty of Medicine, University of Malaga, Málaga, Spain.,Centro de Investigaciones Médico-Sanitarias (C.I.M.E.S), University of Malaga, Málaga, Spain.,Área de Enfermedades cardiovasculares, obesidad y diabetes, Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Marina Fernández-Andújar
- Universitat Abat Oliba CEU, CEU Universities, Facultad de Ciencias Sociales, Departamento Psicología
| | | | - Silvia Maraver-Selfa
- Department of Endocrinology, Virgen de la Victoria University Hospital, Malaga, Spain
| | | | - José R Ramos-Rodriguez
- Centro de Investigaciones Médico-Sanitarias (C.I.M.E.S), University of Malaga, Málaga, Spain
| | - Francisco Alfaro-Rubio
- Centro de Investigaciones Médico-Sanitarias (C.I.M.E.S), University of Malaga, Málaga, Spain
| | - Nuria Roé-Vellvé
- Centro de Investigaciones Médico-Sanitarias (C.I.M.E.S), University of Malaga, Málaga, Spain
| | - Isabel Garcia-Garcia
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Juan A García-Arnés
- Department of Endocrinology, Regional University Hospital of Malaga, Malaga, Spain.,Department of Pharmacology, Faculty of Medicine, University of Malaga, Malaga, Spain
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Torre C, Cary M, Borges FC, Ferreira PS, Alarcão J, Leufkens HG, Costa J, Martins AP. Intensive Monitoring Studies for Assessing Medicines: A Systematic Review. Front Med (Lausanne) 2019; 6:147. [PMID: 31380375 PMCID: PMC6659411 DOI: 10.3389/fmed.2019.00147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 06/12/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction: Intensive monitoring (IM) is one of the methods of post-marketing active surveillance based upon event monitoring, which has received interest in the current medicines regulatory landscape. For a specific period of time, IM involves primary data collection and is actively focused on gathering longitudinal information, mainly safety, since the first day of drug use. Objectives: To describe IM systems and studies' data published over 11-years period (2006-2016). Specifically, we reviewed study population/event surveillance, methodological approaches, limitations, and its applications in the real-world evidence generation data. Methods: We completed a systematic search of MEDLINE and EMBASE to identify studies published from 2006 to 2016, that used IM methodology. We extracted data using a standardized form and results were analyzed descriptively. The methodological quality of selected studies was assessed using the modified Downs and Black checklist. Results: From 1,400 screened citations, we identified 86 papers, corresponding to 69 different studies. Seventy percent of reviewed studies corresponded to established IM systems, of which, more than half were prescription event monitoring (PEM) and modified-PEM. Among non-established IM systems, vaccines were the most common studied drugs (n = 14). The median cohort size ranged from 488 (hospitals) to 10,479 (PEM) patients. Patients and caregivers were the event data source in 39.1% of studies. The mean overall quality score was similar between established and non-established IM. Conclusions: Over the study period, IM studies were implemented in 26 countries with different maturity levels of post-marketing surveillance systems. We identified two major limitations: only 20% of studies were conducted at hospital-level, which is a matter of concern, insofar as healthcare systems are facing a lack of access to new medicines at ambulatory care level. Additionally, IM access to data of drug exposure cohorts, either at identification or at follow-up stages, could somehow constitute a barrier, given the complexity of managerial, linkable, and privacy data issues.
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Affiliation(s)
- Carla Torre
- Centre for Health Evaluation and Research (CEFAR), National Association of Pharmacies, Lisbon, Portugal
- Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Maria Cary
- Centre for Health Evaluation and Research (CEFAR), National Association of Pharmacies, Lisbon, Portugal
| | - Fábio Cardoso Borges
- Department of Epidemiology and National Cancer Registry (RON), Portuguese Institute of Oncology, Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Paula S. Ferreira
- Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
- Setubal and Santarem Regional Pharmacovigilance Unit, Lisbon, Portugal
| | - Joana Alarcão
- Faculty of Medicine, Center for Evidence-Based Medicine, University of Lisbon, Lisbon, Portugal
| | - Hubert G. Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - João Costa
- Faculty of Medicine, Center for Evidence-Based Medicine, University of Lisbon, Lisbon, Portugal
- Faculty of Medicine, Institute of Molecular Medicine and Laboratory of Clinical Pharmacology and Therapeutics, University of Lisbon, Lisbon, Portugal
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Peral C, Cordido F, Gimeno-Ballester V, Mir N, Sánchez-Cenizo L, Rubio-Rodríguez D, Rubio-Terrés C. Cost-effectiveness analysis of second-line pharmacological treatment of acromegaly in Spain. Expert Rev Pharmacoecon Outcomes Res 2019; 20:105-114. [PMID: 31055976 DOI: 10.1080/14737167.2019.1610396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: To estimate the cost-effectiveness of second-line pharmacological treatments in patients with acromegaly resistant to first-generation somatostatin analogues (FG SSA) from the Spanish National Health System (NHS) perspective.Methods: A Markov model was developed to analyze the cost-effectiveness of pegvisomant and pasireotide in FG SSA-resistant acromegaly, simulating a cohort of patients from the treatment beginning to death. Treatment with pegvisomant or pasireotide was compared to FG SSA retreatment. Efficacy data were obtained from clinical trials and utilities from the literature. Direct health costs were obtained from Spanish sources (€2018).Results: The Incremental Cost Effectiveness Ratio (ICER) of pegvisomant vs. FG SSA was €85,869/Quality-adjusted life years (QALY). The ICER of pasireotide vs. FG SSA was €551,405/QALY. The ICER was mainly driven by the incremental efficacy (4.41 QALY for pegvisomant vs. FG SSA and 0.71 QALY for pasireotide vs. FG SSA), with a slightly lower increase in costs with pegvisomant (€378,597 vs. FG SSA) than with pasireotide (€393,151 vs. FG SSA).Conclusion: The ICER of pasireotide compared to FG SSA was six times higher than the ICER of pegvisomant vs. FG SSA. Pegvisomant is a more cost-effective alternative for the treatment of acromegaly in FG SSA-resistant patients in the Spanish NHS.
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Affiliation(s)
- Carmen Peral
- Health Economics and Outcomes Research Department, Pfizer S.L.U, Alcobendas (Madrid), Spain
| | - Fernando Cordido
- Endocrinology Department, Complejo Hospitalario Universitario A Coruña, and Universidad de A Coruña, A Coruña, Spain
| | | | - Nuria Mir
- Medical Affairs Department, Pfizer S.L.U, Alcobendas (Madrid), Spain
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Cámara R, Venegas E, García-Arnés JA, Cordido F, Aller J, Samaniego ML, Mir N, Sánchez-Cenizo L. Treatment adherence to pegvisomant in patients with acromegaly in Spain: PEGASO study. Pituitary 2019; 22:137-145. [PMID: 30756345 DOI: 10.1007/s11102-019-00943-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE The burden of chronic daily subcutaneous administration of pegvisomant on adherence has not been previously studied. This study was aimed to determine the adherence to pegvisomant treatment in acromegaly patients in the real-world clinical practice setting in Spain. METHODS Multicenter, observational, descriptive, cross-sectional study in patients with acromegaly treated with pegvisomant for at least 12 months. Patient adherence was indirectly determined by Batalla and Haynes-Sackett questionnaires and directly by prescription record review. Additionally, treatment satisfaction was assessed by the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) and treatment convenience by an ad-hoc Pegvisomant questionnaire. Errors in reconstitution and administration process were determined by direct observation. RESULTS 108 patients were included in the analysis. Rates of adherence varied from 60.7 to 92.1% and did not correlate with disease control. Older patient age and alternative schedules other than daily pegvisomant dosing were associated with lower adherence. Treatment satisfaction and convenience was high, with a mean (SD) total SATMED-Q score of 74.6 ± 15.4 over 100 and a total ad-hoc Pegvisomant questionnaire score of 71.2 ± 15.2 over 100. 34.3% of patients made mistakes during the reconstitution /administration process. CONCLUSIONS Patient adherence to pegvisomant was high (60.7-92.1%), but more than a third of the patients in the study made mistakes during the administration process, with a potential impact on disease control. Besides dosing compliance, correct administration of medication should be carefully assessed in these patients.
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Affiliation(s)
- Rosa Cámara
- Hospital Universitario y Politécnico La Fe, Avenida de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Eva Venegas
- Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot, s/n, 41013, Sevilla, Spain
| | | | - Fernando Cordido
- Complejo Hospitalario Universitario A Coruña, As Xubias, 84, 15006, La Coruña, Spain
| | - Javier Aller
- Hospital Universitario Puerta de Hierro-Majadahonda, Calle Manuel de Falla, 1, 28222, Majadahonda, Madrid, Spain
| | - M Luz Samaniego
- TFS Statistical Services, Avda. Europa, 20B. Parque Empresarial La Moraleja, 28108, Alcobendas, Madrid, Spain
| | - Nuria Mir
- Pfizer S.L.U, Avda. Europa, 20B. Parque Empresarial La Moraleja, 28108, Alcobendas, Madrid, Spain
| | - Laura Sánchez-Cenizo
- Pfizer S.L.U, Avda. Europa, 20B. Parque Empresarial La Moraleja, 28108, Alcobendas, Madrid, Spain.
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9
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Leonart LP, Tonin FS, Ferreira VL, Fernandez-Llimos F, Pontarolo R. Effectiveness and safety of pegvisomant: a systematic review and meta-analysis of observational longitudinal studies. Endocrine 2019; 63:18-26. [PMID: 30145746 DOI: 10.1007/s12020-018-1729-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 08/16/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE Acromegaly is a rare disease that often requires drug treatment to achieve control, with pegvisomant being one of the most widely used therapies. In the present paper, we aimed to obtain evidence regarding the effectiveness and safety of pegvisomant by reviewing real-world observational longitudinal studies. METHODS A systematic review was performed with a meta-analysis of event rates (95% confidence interval (CI)) using a random effects model. Sensitivity and subgroup analyses were performed (comprehensive meta-analysis 2.0). The systematic review was performed in accordance to preferred reporting items for systematic reviews and meta-analyses, meta-analysis of observational studies in epidemiology, and Cochrane recommendations (PROSPERO register CRD 42017059880). PubMed, Scopus, Web of Science, and SciELO were used to search for literature. Observational studies in patients using pegvisomant for the treatment of acromegaly were included. RESULTS Initially, 552 papers were retrieved from the databases; and 31 articles were included in the qualitative analysis and 14 in the quantitative analysis. Eight primary meta-analyses were performed. The overall rate of patients with disease control was of 60.9% (51.8-69.3%; 95% CI). When considering patients under monotherapy, the control rate was 71.7% (64.0-78.4%; 95% CI). Tumor growth was estimated in 7.3% (4.7-11.1%; 95% CI) and elevation of transaminases in 3.0% (1.7-5.2%; 95% CI). CONCLUSIONS The real-world data showed that the effectiveness of pegvisomant is not as high as reported in interventional studies. Acromegaly appears to be better controlled when pegvisomant is used as a monotherapy. No serious adverse events were associated with the use of pegvisomant; however, given the high cost of this drug, further studies are required.
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Affiliation(s)
- Letícia P Leonart
- Universidade Federal do Paraná, Graduate Program in Pharmaceutical Sciences, Curitiba, Paraná, Brazil
| | - Fernanda S Tonin
- Universidade Federal do Paraná, Graduate Program in Pharmaceutical Sciences, Curitiba, Paraná, Brazil
| | - Vinicius L Ferreira
- Universidade Federal do Paraná, Graduate Program in Pharmaceutical Sciences, Curitiba, Paraná, Brazil
| | - Fernando Fernandez-Llimos
- Research Institute for Medicines (iMed.ULisboa), Department of Social Pharmacy, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Roberto Pontarolo
- Universidade Federal do Paraná, Graduate Program in Pharmaceutical Sciences, Curitiba, Paraná, Brazil.
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10
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Buchfelder M, van der Lely AJ, Biller BMK, Webb SM, Brue T, Strasburger CJ, Ghigo E, Camacho-Hubner C, Pan K, Lavenberg J, Jönsson P, Hey-Hadavi JH. Long-term treatment with pegvisomant: observations from 2090 acromegaly patients in ACROSTUDY. Eur J Endocrinol 2018; 179:419-427. [PMID: 30325178 DOI: 10.1530/eje-18-0616] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/01/2018] [Indexed: 12/12/2022]
Abstract
Objectives ACROSTUDY is an international, non-interventional study of acromegaly patients treated with pegvisomant (PEGV), a growth hormone receptor antagonist and has been conducted since 2004 in 15 countries to study the long-term safety and efficacy of PEGV. This report comprises the second interim analysis of 2090 patients as of May 12, 2016. Methods Descriptive analyses of safety, pituitary imaging and outcomes on PEGV treatment up to 12 years were performed. Results Prior to starting PEGV, 96% of patients had reported surgery, radiation, medical therapy or any combinations of those. At start of PEGV, 89% of patients had IGFI levels above the upper limit of normal (ULN). The percentage of patients with normal IGFI levels increased from 53% at year 1 to 73% at year 10, and the average daily dose of PEGV increased from 12.8 mg (year 1) to 18.9 mg (year 10). A total of 4832 adverse events (AEs) were reported in 1137 patients (54.4%), of which 570 were considered treatment related in 337 patients (16.1%). Serious AEs were reported in 22% of patients, of which 2.3% were considered treatment related. Locally reported MRIs showed most patients (72.2%) had no change in tumor size relative to the prior scan; 16.8% had a decrease, 6.8% an increase and 4.3% both. In patients with normal liver tests at PEGV start, an ALT or AST elevation of >3× ULN at any time point during their follow-up was reported in 3%. Conclusions This second interim analysis confirms that long-term use of PEGV is an effective and safe treatment in patients with acromegaly.
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Affiliation(s)
- Michael Buchfelder
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | | | - Beverly M K Biller
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Susan M Webb
- Endocrinologia (Malalties de la Hipòfisi), Hospital Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Thierry Brue
- Department of Endocrinology, Centre de Référence des Maladies Rares d'Origine Hypophysaire, Hôpital de la Conception, Marseille, France
| | - Christian J Strasburger
- Department of Medicine for Endocrinology, Diabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Berlin, Germany
| | - Ezio Ghigo
- University Hospital Città Salute e Scienza, Turin, Italy
| | | | - Kaijie Pan
- Endocrine Care Global Clinical Affairs, Pfizer Inc., Collegeville, Pennsylvania, USA
| | - Joanne Lavenberg
- Endocrine Care Global Clinical Affairs, Pfizer Inc., Collegeville, Pennsylvania, USA
| | - Peter Jönsson
- Endocrine Care, Pfizer Health AB, Sollentuna, Sweden
| | - Juliana H Hey-Hadavi
- Endocrine Care Global Medical Affairs, Pfizer Inc., New York City, New York, USA
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11
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Bernabeu I, Cámara R, Marazuela M, Puig Domingo M. Documento de expertos sobre el manejo de la acromegalia. ENDOCRINOL DIAB NUTR 2018; 65:428-437. [DOI: 10.1016/j.endinu.2018.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 11/26/2022]
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12
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Leonart LP, Ferreira VL, Tonin FS, Fernandez-Llimos F, Pontarolo R. Medical Treatments for Acromegaly: A Systematic Review and Network Meta-Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:874-880. [PMID: 30005760 DOI: 10.1016/j.jval.2017.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/28/2017] [Accepted: 12/11/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Acromegaly results from the hypersecretion of growth hormone. Because of the low incidence rates of this disease worldwide, few clinical trials evaluating drug treatments have been conducted. OBJECTIVES To conduct the first network meta-analysis simultaneously comparing all available drugs used in acromegaly treatment so as to provide more robust evidence in this field. METHODS A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane Collaboration recommendations (PROSPERO database under the registration number CRD42017059880). The electronic searches were conducted in PubMed (MEDLINE), Scopus, and Web of Science databases. Randomized controlled trials comparing any drug for the treatment of acromegaly head-to-head or versus placebo were included. Outcomes concerning the efficacy and safety of treatments were evaluated. The statistical analyses were performed using Aggregate Data Drug Information System version 1.16.8 (drugis.org, Groningen, The Netherlands). RESULTS The initial search retrieved 2059 articles. Of these, 10 randomized controlled trials were included in a qualitative analysis and 7 in a quantitative analysis. The network meta-analysis for the efficacy outcome (number of patients achieving insulinlike growth factor 1 control) showed that pegvisomant and lanreotide autogel were statistically superior to placebo (odds ratio [95% credible interval] 0.06 [0.00-0.55] and 0.09 [0.01-0.88]). No further differences were found. The probability rank indicated that pegvisomant and pasireotide have the highest probabilities (33% and 34%, respectively) of being the best therapeutic options. No major side effects were noted. CONCLUSIONS Pegvisomant is still a good option for acromegaly treatment, but pasireotide seems to be a promising alternative. Nevertheless, other important key factors such as drug costs and effectiveness (real-world results) should be taken into account when selecting acromegaly treatment.
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Affiliation(s)
- Letícia P Leonart
- Graduate Program in Pharmaceutical Sciences, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Vinicius L Ferreira
- Graduate Program in Pharmaceutical Sciences, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Fernanda S Tonin
- Graduate Program in Pharmaceutical Sciences, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Fernando Fernandez-Llimos
- Department of Social Pharmacy, Faculty of Pharmacy, Research Institute for Medicines (iMed.ULisboa), Universidade de Lisboa, Lisbon, Portugal
| | - Roberto Pontarolo
- Graduate Program in Pharmaceutical Sciences, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.
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13
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Ragonese M, Grottoli S, Maffei P, Alibrandi A, Ambrosio MR, Arnaldi G, Bianchi A, Puglisi S, Zatelli MC, De Marinis L, Ghigo E, Giustina A, Maffezzoni F, Martini C, Trementino L, Cannavo S. How to improve effectiveness of pegvisomant treatment in acromegalic patients. J Endocrinol Invest 2018; 41:575-581. [PMID: 29080965 DOI: 10.1007/s40618-017-0773-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/10/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Pegvisomant (PEGV) treatment in acromegaly patients resistant to somatostatin analogues is less effective in the real life than in clinical trials. This is a multicenter, observational, retrospective, longitudinal study. The aim was to detect characteristics which improve long-term PEGV effectiveness. METHODS 87 acromegalic patients treated with PEGV have been enrolled in seven referral Italian centres. PEGV was administered for up to 4 years, at doses up titrated until IGF-1 normalization or to ≥ 30 mg/day. The rate of patients who reached IGF-1 normalization at last visit has been calculated. RESULTS IGF-1 was normalized in 75.9% of patients after 1 year and in 89.6% at last visit. Disease control was associated with lower baseline GH, IGF-1 and IGF-1 xULN and was more frequent when baseline IGF-1 was < 2.7 × ULN (p < 0.02). PEGV dose was dependent on baseline IGF-1 > 2.7 × ULN (p < 0.05) and doses > 1.0 mg/BMI/day were administered more frequently when baseline IGF-1 was > 2.0 × ULN (p = 0.03). PEGV resistance was associated with higher BMI (p = 0.006) and was more frequent when BMI was > 30 kg/m2 (p = 0.07). There were no significant differences between patients treated with monotherapy or combined treatment. IGF-1 normalization, PEGV dose and rate of associated treatment were similar between males and females. PEGV effectiveness was independent from previous management. Diabetic patients needed higher doses of PEGV than non-diabetic ones. CONCLUSIONS 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.
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Affiliation(s)
- M Ragonese
- Dipartimento di Patologia Umana dell'adulto e dell'età evolutiva "G. Barresi", AOU Policlinico G. Martino, University of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - S Grottoli
- Divisione di Endocrinologia, Diabetologia E Metabolismo, Dipartimento di Scienze Mediche, AO Città Della Salute E Della Scienza di Torino, Università di Torino, Turin, Italy
| | - P Maffei
- Dipartimento di Medicina, AO di Padova, Padua, Italy
| | - A Alibrandi
- Dipartimento di Economia, Sezione di Scienze Statistiche E Matematiche, Università di Messina, Messina, Italy
| | - M R Ambrosio
- Dipartimento di Scienze Mediche, Sezione di Endocrinologia E Medicina Interna, Università di Ferrara, Ferrara, Italy
| | - G Arnaldi
- SOD Clinica di Endocrinologia E Malattie Del Metabolismo, AOU Ospedali Riuniti di Ancona, Università di Ancona, Torrette, Ancona, Italy
| | - A Bianchi
- UOS Patologia Ipofisaria, Istituto di Patologia Medica, Policlinico Universitario A. Gemelli, Rome, Italy
| | - S Puglisi
- Dipartimento di Patologia Umana dell'adulto e dell'età evolutiva "G. Barresi", AOU Policlinico G. Martino, University of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - M C Zatelli
- Dipartimento di Scienze Mediche, Sezione di Endocrinologia E Medicina Interna, Università di Ferrara, Ferrara, Italy
| | - L De Marinis
- UOS Patologia Ipofisaria, Istituto di Patologia Medica, Policlinico Universitario A. Gemelli, Rome, Italy
| | - E Ghigo
- Divisione di Endocrinologia, Diabetologia E Metabolismo, Dipartimento di Scienze Mediche, AO Città Della Salute E Della Scienza di Torino, Università di Torino, Turin, Italy
| | - A Giustina
- Struttura Ambulatoriale di Endocrinologia, AO Spedali Civili di Brescia, Università di Brescia, Brescia, Italy
| | - F Maffezzoni
- Struttura Ambulatoriale di Endocrinologia, AO Spedali Civili di Brescia, Università di Brescia, Brescia, Italy
| | - C Martini
- Dipartimento di Medicina, AO di Padova, Padua, Italy
| | - L Trementino
- SOD Clinica di Endocrinologia E Malattie Del Metabolismo, AOU Ospedali Riuniti di Ancona, Università di Ancona, Torrette, Ancona, Italy
| | - S Cannavo
- Dipartimento di Patologia Umana dell'adulto e dell'età evolutiva "G. Barresi", AOU Policlinico G. Martino, University of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy.
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Ferraù F, Albani A, Ciresi A, Giordano C, Cannavò S. Diabetes Secondary to Acromegaly: Physiopathology, Clinical Features and Effects of Treatment. Front Endocrinol (Lausanne) 2018; 9:358. [PMID: 30034367 PMCID: PMC6043782 DOI: 10.3389/fendo.2018.00358] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/13/2018] [Indexed: 12/18/2022] Open
Abstract
Acromegaly is a rare disease due to chronic GH excess and to the consequent increase in IGF-1 levels. Both GH and IGF-1 play a role in intermediate metabolism affecting glucose homeostasis. Indeed, chronic GH excess impairs insulin sensitivity, increases gluconeogenesis, reduces the glucose uptake in adipose tissue and muscle and alters pancreatic β cells function. As a consequence, glucose metabolism alterations are a very frequent complication in acromegaly patients, further contributing to the increased cardiovascular risk and mortality. Treatment modalities of acromegaly differently impact on glucose tolerance. Successful surgical treatment of acromegaly ameliorates glucose metabolism abnormalities. Drugs used to treat acromegaly patients may per se affect glucose homeostasis, therefore influencing patients' management. Indeed pegvisomant has been shown to positively impact on glucose metabolism, while somatostatin analogs, especially pasireotide, can cause hyperglycaemia. On the other hand, robust data on the effect of dopamine agonists on glycaemic profile are still lacking. This review summarizes the available data on diabetes mellitus in acromegaly patients, with a focus on the potential effects of the medical treatment of the disease on glucose homeostasis, providing an overview of the current state of the art.
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Affiliation(s)
- Francesco Ferraù
- Department of Human Pathology of Adulthood and Childhood ‘G. Barresi', University of Messina, Messina, Italy
- *Correspondence: Francesco Ferraù
| | - Adriana Albani
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alessandro Ciresi
- Section of Endocrinology, Diabetology and Metabolism, Biomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Palermo, Italy
| | - Carla Giordano
- Section of Endocrinology, Diabetology and Metabolism, Biomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Palermo, Italy
| | - Salvatore Cannavò
- Department of Human Pathology of Adulthood and Childhood ‘G. Barresi', University of Messina, Messina, Italy
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15
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Weiss J, Wood AJ, Zajac JD, Grossmann M, Andrikopoulos S, Ekinci EI. Diabetic ketoacidosis in acromegaly; a rare complication precipitated by corticosteroid use. Diabetes Res Clin Pract 2017; 134:29-37. [PMID: 28951345 DOI: 10.1016/j.diabres.2017.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/16/2017] [Accepted: 08/30/2017] [Indexed: 11/29/2022]
Abstract
Diabetic ketoacidosis has been described in the literature as a rare possible initial presentation of acromegaly before a diagnosis of acromegaly is eventually made. Indeed, diabetic ketoacidosis is a recognised complication of acromegaly. There are a number of factors that can predispose patients with acromegaly to diabetes as well as to diabetic ketoacidosis. These include high levels of growth hormone and insulin-like growth factor 1 in acromegaly and the effect on glycaemia by medications used in the management of acromegaly. Ketoacidosis has been described in patients with acromegaly even without the presence of an underlying autoimmune diabetes. Patients with acromegaly and ketoacidosis often respond to treatment and may not require long-term insulin.
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Affiliation(s)
- Jeremy Weiss
- Department of Endocrinology, Austin Health, Level 2 Centaur Building, Repatriation Campus Heidelberg West, Victoria 3084, Australia
| | - Anna J Wood
- Department of Endocrinology, Austin Health, Level 2 Centaur Building, Repatriation Campus Heidelberg West, Victoria 3084, Australia
| | - Jeffrey D Zajac
- Department of Endocrinology, Austin Health, Level 2 Centaur Building, Repatriation Campus Heidelberg West, Victoria 3084, Australia; Department of Medicine, Austin Health and the University of Melbourne (Austin Campus), Parkville, VIC 3010, Australia
| | - Mathis Grossmann
- Department of Endocrinology, Austin Health, Level 2 Centaur Building, Repatriation Campus Heidelberg West, Victoria 3084, Australia
| | - Sofianos Andrikopoulos
- Department of Medicine, Austin Health and the University of Melbourne (Austin Campus), Parkville, VIC 3010, Australia
| | - Elif I Ekinci
- Department of Endocrinology, Austin Health, Level 2 Centaur Building, Repatriation Campus Heidelberg West, Victoria 3084, Australia; Department of Medicine, Austin Health and the University of Melbourne (Austin Campus), Parkville, VIC 3010, Australia.
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16
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Petrossians P, Daly AF, Natchev E, Maione L, Blijdorp K, Sahnoun-Fathallah M, Auriemma R, Diallo AM, Hulting AL, Ferone D, Hana V, Filipponi S, Sievers C, Nogueira C, Fajardo-Montañana C, Carvalho D, Hana V, Stalla GK, Jaffrain-Réa ML, Delemer B, Colao A, Brue T, Neggers SJCMM, Zacharieva S, Chanson P, Beckers A. Acromegaly at diagnosis in 3173 patients from the Liège Acromegaly Survey (LAS) Database. Endocr Relat Cancer 2017; 24:505-518. [PMID: 28733467 PMCID: PMC5574208 DOI: 10.1530/erc-17-0253] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 07/21/2017] [Indexed: 12/27/2022]
Abstract
Acromegaly is a rare disorder caused by chronic growth hormone (GH) hypersecretion. While diagnostic and therapeutic methods have advanced, little information exists on trends in acromegaly characteristics over time. The Liège Acromegaly Survey (LAS) Database, a relational database, is designed to assess the profile of acromegaly patients at diagnosis and during long-term follow-up at multiple treatment centers. The following results were obtained at diagnosis. The study population consisted of 3173 acromegaly patients from ten countries; 54.5% were female. Males were significantly younger at diagnosis than females (43.5 vs 46.4 years; P < 0.001). The median delay from first symptoms to diagnosis was 2 years longer in females (P = 0.015). Ages at diagnosis and first symptoms increased significantly over time (P < 0.001). Tumors were larger in males than females (P < 0.001); tumor size and invasion were inversely related to patient age (P < 0.001). Random GH at diagnosis correlated with nadir GH levels during OGTT (P < 0.001). GH was inversely related to age in both sexes (P < 0.001). Diabetes mellitus was present in 27.5%, hypertension in 28.8%, sleep apnea syndrome in 25.5% and cardiac hypertrophy in 15.5%. Serious cardiovascular outcomes like stroke, heart failure and myocardial infarction were present in <5% at diagnosis. Erythrocyte levels were increased and correlated with IGF-1 values. Thyroid nodules were frequent (34.0%); 820 patients had colonoscopy at diagnosis and 13% had polyps. Osteoporosis was present at diagnosis in 12.3% and 0.6-4.4% had experienced a fracture. In conclusion, this study of >3100 patients is the largest international acromegaly database and shows clinically relevant trends in the characteristics of acromegaly at diagnosis.
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Affiliation(s)
| | - Adrian F Daly
- Department of EndocrinologyCHU de Liège, University of Liège, Belgium
| | - Emil Natchev
- Clinical Centre of Endocrinology and GerontologyMedical University, Sofia, Bulgaria
| | - Luigi Maione
- APHP Endocrinology and Reproductive DiseasesParis Sud University, Le Kremlin-Bicêtre, France
| | - Karin Blijdorp
- Section of EndocrinologyDepartment of Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mona Sahnoun-Fathallah
- Department of EndocrinologyCentre de Référence des Maladies Rares d'Origine Hypophysaire, Hôpital de la Timone, Marseille, France
| | - Renata Auriemma
- Dipartimento Di Medicina Clinica e ChirurgiaSezione di Endocrinologia, University "Federico II", Naples, Italy
| | | | - Anna-Lena Hulting
- Department of Molecular Medicine and SurgeryKarolinska University Hospital, Stockholm, Sweden
| | - Diego Ferone
- Department of Internal MedicineUniversity of Genoa, Genova, Italy
| | - Vaclav Hana
- Third Department of Internal Medicine1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Silvia Filipponi
- Department of Biotechnological and Applied Clinical SciencesUniversity of L'Aquila, L'Aquila, Italy and Neuromed, IRCCS, Pozzilli, Italy
| | - Caroline Sievers
- Department of Internal MedicineEndocrinology and Clinical Chemistry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Claudia Nogueira
- Department of Internal MedicineEndocrinology, Diabetes and Metabolism Unit, Centro Hospitalar de Trás-os-Montes e Alto Douro, Portugal
| | | | - Davide Carvalho
- Department of EndocrinologyDiabetes and Metabolism, Centro Hospitalar S. João, Faculty of Medicine, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Vaclav Hana
- Third Department of Internal Medicine1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Günter K Stalla
- Department of Internal MedicineEndocrinology and Clinical Chemistry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Marie-Lise Jaffrain-Réa
- Department of Biotechnological and Applied Clinical SciencesUniversity of L'Aquila, L'Aquila, Italy and Neuromed, IRCCS, Pozzilli, Italy
| | | | - Annamaria Colao
- Dipartimento Di Medicina Clinica e ChirurgiaSezione di Endocrinologia, University "Federico II", Naples, Italy
| | - Thierry Brue
- Department of EndocrinologyCentre de Référence des Maladies Rares d'Origine Hypophysaire, Hôpital de la Timone, Marseille, France
| | - Sebastian J C M M Neggers
- Section of EndocrinologyDepartment of Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sabina Zacharieva
- Clinical Centre of Endocrinology and GerontologyMedical University, Sofia, Bulgaria
| | - Philippe Chanson
- APHP Endocrinology and Reproductive DiseasesParis Sud University, Le Kremlin-Bicêtre, France
| | - Albert Beckers
- Department of EndocrinologyCHU de Liège, University of Liège, Belgium
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Tritos NA, Chanson P, Jimenez C, King D, Jönsson PJ, Klibanski A, Biller BMK. Effectiveness of first-line pegvisomant monotherapy in acromegaly: an ACROSTUDY analysis. Eur J Endocrinol 2017; 176:213-220. [PMID: 27932529 DOI: 10.1530/eje-16-0697] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/04/2016] [Accepted: 11/15/2016] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To examine the effectiveness and safety of primary pegvisomant monotherapy. DESIGN Retrospective analysis of data extracted from ACROSTUDY (global observational outcomes study of patients with acromegaly treated with pegvisomant). METHODS The earliest time to insulin-like growth factor 1 (IGF-1) normalization on pegvisomant monotherapy was determined. Both the proportion of patients who achieved IGF-1 normalization and the time to IGF-1 normalization on pegvisomant monotherapy were assessed. RESULTS Eligible patients included 28 subjects on primary medical therapy (PT) and 176 controls on adjunctive pegvisomant therapy treated postoperatively, including 43 who were naïve to medical therapy (NMT) and 133 who were previously treated medically and were washed out (WASH). IGF-1 normalization occurred in 76.9% (PT), 85.2% (NMT) and 78.3% (WASH) patients (P = NS). Median times to IGF-1 normalization were 0.5 year (PT), 0.7 year (NMT) and 0.6 year (WASH), P = NS. On survival analysis, the fraction of patients controlled on pegvisomant monotherapy was not different between groups. Higher baseline IGF-1 levels, obtained at study entry, predicted a lower likelihood of IGF-1 normalization on monotherapy (P = 0.012). Safety data include low prevalence of skin rashes, injection site reactions and reversible transaminase elevations. There was one patient (NMT) with a verified increase in tumor size. CONCLUSIONS Pegvisomant monotherapy, administered either as primary medical therapy or as adjunctive therapy according to local practice, led to IGF-1 normalization in >75% of patients. Pegvisomant monotherapy had a favorable safety profile, consistent with previous observations. Prospective data are needed to further evaluate the role of primary pegvisomant monotherapy in acromegaly.
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Affiliation(s)
- Nicholas A Tritos
- Neuroendocrine UnitMassachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, France
- Institut National de la Santé et de la Recherche Médicale U1185Fac Med Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Camilo Jimenez
- Endocrine Neoplasia and Hormonal DisordersThe University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Donna King
- Endocrine CarePfizer, Inc, Lawrenceville, New Jersey, USA
| | | | - Anne Klibanski
- Neuroendocrine UnitMassachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Beverly M K Biller
- Neuroendocrine UnitMassachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Abstract
PURPOSE To review published data on pegvisomant and its therapeutic role in acromegaly. METHODS Electronic searches of the published literature were conducted using the keywords: acromegaly, growth hormone (GH) receptor (antagonist), pegvisomant, therapy. Relevant articles (n = 141) were retrieved and considered for inclusion in this manuscript. RESULTS Pegvisomant is a genetically engineered, recombinant growth hormone receptor antagonist, which is effective in normalizing serum insulin-like growth factor 1 (IGF-1) levels in the majority of patients with acromegaly and ameliorating symptoms and signs associated with GH excess. Pegvisomant does not have direct antiproliferative effects on the underlying somatotroph pituitary adenoma, which is the etiology of GH excess in the vast majority of patients with acromegaly. Therefore, patients receiving pegvisomant monotherapy require regular pituitary imaging in order to monitor for possible increase in tumor size. Adverse events in patients on pegvisomant therapy include skin rashes, lipohypertrophy at injection sites, and idiosyncratic liver toxicity (generally asymptomatic transaminitis that is reversible upon drug discontinuation), thus necessitating regular patient monitoring. CONCLUSIONS Pegvisomant is an effective therapeutic agent in patients with acromegaly who are not in remission after undergoing pituitary surgery. It mitigates excess GH action, as demonstrated by IGF-1 normalization, but has no direct effects on pituitary tumors causing acromegaly. Regular surveillance for possible tumor growth and adverse effects (hepatotoxicity, skin manifestations) is warranted.
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Affiliation(s)
- Nicholas A Tritos
- Neuroendocrine Unit, Massachusetts General Hospital, Zero Emerson Place # 112, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Beverly M K Biller
- Neuroendocrine Unit, Massachusetts General Hospital, Zero Emerson Place # 112, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
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