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Grottoli S, Bianchi A, Bogazzi F, Bona C, Carlsson MO, Colao A, Dassie F, Giampietro A, Gomez R, Granato S, Maffei P, Pivonello R, Prencipe N, Ragonese M, Urbani C, Cannavò S. Are there country-specific differences in the use of pegvisomant for acromegaly in clinical practice? An analysis from ACROSTUDY. J Endocrinol Invest 2022; 45:1535-1545. [PMID: 35359232 PMCID: PMC9270309 DOI: 10.1007/s40618-022-01789-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/16/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE A comprehensive picture of pegvisomant use for treating acromegaly in routine clinical practice in different countries is lacking. We aimed, therefore, to document country-specific behaviors in real-life pegvisomant use, and the main safety and effectiveness outcomes in the ACROSTUDY. DESIGN ACROSTUDY is an open-label, non-interventional, post-marketing safety surveillance study. METHODS A descriptive analysis was performed using data from the six top-recruiter ACROSTUDY countries, i.e., Germany (n = 548 patients), Italy (n = 466), France (n = 312), USA (n = 207), Spain (n = 200) and the Netherlands (n = 175). These nations accounted for > 85% of the ACROSTUDY cases. RESULTS The mean pegvisomant dose at treatment start was lowest in the Netherlands (9.4 mg/day), whereas it ranged between 10.9 and 12.6 mg/day in the other countries. At year 5, the mean pegvisomant dose was around 15 mg/day in all countries, except France (18.1 mg/day). At starting pegvisomant, patients treated with monotherapy ranged between 15% in the Netherlands and 72% in Spain. Monotherapy remained lowest over time in the Netherlands. In all countries, the percentage of patients with normal IGF-1 increased steeply from < 20% at baseline to 43-58% at month 6 and 51-67% at year 1. After that, we observed minor changes in the rate of acromegaly control in all countries. The Netherlands peaked in disease control at year 2 (72%). The proportion of patients reporting changes in pituitary tumor size was generally low. Serious treatment-related adverse events were < 5% in all countries. CONCLUSIONS Our study provided a detailed summary of real-life use of pegvisomant in the six top-recruiter ACROSTUDY nations.
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Affiliation(s)
- S Grottoli
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
| | - A Bianchi
- Pituitary Unit, Department of Endocrinology, Fondazione A Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Bogazzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Bona
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M O Carlsson
- Global Medical Affairs, Pfizer Rare Disease, Brussels, Belgium
| | - A Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, 80131, Naples, Italy
| | - F Dassie
- Department of Medicine, Padua University Hospital, Padua, Italy
| | - A Giampietro
- Pituitary Unit, Department of Endocrinology, Fondazione A Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Gomez
- Global Medical Affairs, Pfizer Rare Disease, Brussels, Belgium
| | - S Granato
- Medical Department, Pfizer Italia, Rome, Italy
| | - P Maffei
- Department of Medicine, Padua University Hospital, Padua, Italy
| | - R Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, 80131, Naples, Italy
| | - N Prencipe
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M Ragonese
- Unit of Endocrinology, Department of Human Pathology, University of Messina, Messina, Italy
| | - C Urbani
- Endocrinology II Unit, Department of Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Cannavò
- Unit of Endocrinology, Department of Human Pathology, University of Messina, Messina, Italy
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Barraud S, Caron P, Raingeard I, Lefebvre H, Raverot G, Cortet-Rudelli C, Desailloud R, Henocque R, Brault Y, Brue T, Chanson P, Delemer B. Pegvisomant treatment in acromegaly in clinical practice: Final results of the French ACROSTUDY (312 patients). ANNALES D'ENDOCRINOLOGIE 2021; 82:582-589. [PMID: 34256010 DOI: 10.1016/j.ando.2021.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/19/2021] [Accepted: 05/21/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We report the final analysis of the French ACROSTUDY, using data revised and enriched since the 2013 interim analysis. Our objective was to validate the use of pegvisomant (PEGV) in the treatment of acromegaly and to determine efficacy and safety. PATIENTS AND METHODS Patients with acromegaly treated with PEGV and followed up for at least 5 years were included. Eighty-eight investigators from 62 clinical centers in France included patients from April 2007 to April 2014. PEGV dose and administration frequency were determined by the physicians, based on their clinical evaluation and local habits. No additional examinations beyond those performed in normal follow-up were required. Minimum recommended follow-up included check-ups at treatment initiation, 6 months, 12 months and then annually. RESULTS In total, 312 patients were enrolled. Mean age was 46.1±14.3 years at introduction of PEGV. Median PEGV treatment duration was 6.3 years and median follow-up was 5.6 years. Median dose at initiation was 10mg/day. The percentages of patients with IGF-1 ≤ ULN (upper limit of normal) were 10% (n=300) at baseline, 54% at 6 months (n=278), and 61.7% (n=253) at 2 years, then stabilizing at 64.4% (n=180) at 5 years. Mean PEGV dose was 17.4±11.7mg in patients with controlled disease versus 21.1±17.3mg in those without control at 5 years. At 5 years, 21.8% of patients (54/248) were receiving >30mg PEGV per day. In patients with at least one pituitary imaging procedure during the 5-year follow-up (n=292), the most recent image showed stable tumor volume in 212 subjects (72.6%), increased volume in 13 (4.5%), and decreased volume in 30 (10.3%). No PEGV treatments were permanently discontinued due to transaminase elevation. There were no cases of liver failure. CONCLUSION The French ACROSTUDY showed normalization of IGF-1 levels in 64.4% of a real-life cohort of patients, mostly with uncontrolled disease despite multiple prior therapies. Long-term follow-up showed a sustained effectiveness and good long-term safety.
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Affiliation(s)
- Sara Barraud
- CRESTIC EA 3804, université de Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Moulin de la Housse, BP 1039, 51687 Reims cedex 2, France; Service d'Endocrinologie-Diabète-Nutrition, CHU de Reims, hôpital Robert Debré, avenue du Général Koenig, 51092 Reims cedex, France.
| | - Philippe Caron
- Service d'endocrinologie et maladies métaboliques, pôle cardio-vasculaire et métabolique, hôpital Larrey, CHU de Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France.
| | - Isabelle Raingeard
- Maladies endocriniennes, hôpital Lapeyronie, CHRU de Montpellier, 295, avenue du Doyen Gaston Giraud, 34295 Montpellier cedex 5, France.
| | - Hervé Lefebvre
- CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
| | - Gérald Raverot
- Hospices civils de Lyon, hôpital Louis-Pradel, 59, boulevard Pinel, 69677 Bron cedex, France.
| | | | - Rachel Desailloud
- CHU d'Amiens, hôpital Nord, place Victor Pauchet, 80054 Amiens cedex 1, France.
| | - Robin Henocque
- Pfizer France, 23-25, avenue du Docteur Lannelongue, 75668 Paris cedex 14, France.
| | - Yves Brault
- Pfizer France, 23-25, avenue du Docteur Lannelongue, 75668 Paris cedex 14, France.
| | - Thierry Brue
- Department of Endocrinology, Centre de référence des maladies rares de l'hypophyse HYPO, hôpital de la Conception, AP-HM, 13005 Marseille, France; INSERM, U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille université, Marseille, France.
| | - Philippe Chanson
- Centre de référence des maladies rares de l'hypophyse HYPO, AP-HP, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre, France; Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Université Paris-Saclay, university Paris-Sud, Inserm, Le Kremlin-Bicêtre, France.
| | - Brigitte Delemer
- CRESTIC EA 3804, université de Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Moulin de la Housse, BP 1039, 51687 Reims cedex 2, France; Service d'Endocrinologie-Diabète-Nutrition, CHU de Reims, hôpital Robert Debré, avenue du Général Koenig, 51092 Reims cedex, France.
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Vila G, Luger A, van der Lely AJ, Neggers SJCMM, Webb SM, Biller BMK, Valluri S, Hey-Hadavi J. Hypertension in Acromegaly in Relationship to Biochemical Control and Mortality: Global ACROSTUDY Outcomes. Front Endocrinol (Lausanne) 2020; 11:577173. [PMID: 33329385 PMCID: PMC7734123 DOI: 10.3389/fendo.2020.577173] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/20/2020] [Indexed: 12/22/2022] Open
Abstract
CONTEXT Hypertension is a major cardiovascular risk factor related to increased mortality in acromegaly. Surgical cure of acromegaly is associated with improvement in blood pressure levels, however little is known about the effect of pegvisomant (PEGV) treatment in patients with hypertension. This analysis evaluates outcomes in patients with hypertension and acromegaly included in ACROSTUDY. METHODS ACROSTUDY is a global non-interventional surveillance study of long-term treatment with PEGV, monitoring its safety and efficacy. The cohort was retrospectively divided in two subgroups: patients with and without hypertension. Stepwise logistic regression and Kaplan-Meyer analyses were performed for testing predictors of mortality. RESULTS The total cohort included 2,090 patients with acromegaly treated with PEGV who were followed for a median of 6.8 years (range up to 12.1 years). In ACROSTUDY there were 1,344 patients with hypertension (52.3% males). This subgroup was older, had a higher BMI, and higher prevalence of diabetes, hyperlipidemia, and cardiovascular disease (CVD) when compared to patients without hypertension. During ACROSTUDY, 68 deaths were reported in the hypertension cohort, vs 10 in the cohort without hypertension. Both CVD (p<0.0001) and anterior pituitary deficiencies (p=0.0105) at study entry independently predicted mortality in patients with acromegaly and hypertension; Kaplan-Meier analysis confirmed that CVD significantly impairs survival. CONCLUSIONS Hypertension is common in patients with acromegaly and significantly increases mortality, especially when there is concomitant CVD. These data suggest that treatment goals should extend beyond IGF-I normalization, and include optimisation of substitution of pituitary deficiencies and scrutinous screening and treatment of CVD.
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Affiliation(s)
- Greisa Vila
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- *Correspondence: Greisa Vila,
| | - Anton Luger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Aart Jan van der Lely
- Pituitary Center Rotterdam, Endocrinology Section, Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Sebastian J. C. M. M. Neggers
- Pituitary Center Rotterdam, Endocrinology Section, Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Susan M. Webb
- IIB-Sant Pau and Service of Endocrinology, Department of Medicine, Centro de Investigacion Biomedica en Enfermedades Raras (CIBER-ER Unidad 747), Hospital Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Srinivas Valluri
- Global Biometrics & Data Management, Pfizer Inc, New York, NY, United States
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Woodmansee WW, Gordon MB, Molitch ME, Ioachimescu AG, Carver DW, Mirakhur B, Cox D, Salvatori R. Screening for comorbid conditions in patients enrolled in the SODA registry: a 2-year observational analysis. Endocrine 2018; 61:105-117. [PMID: 29767287 PMCID: PMC5997114 DOI: 10.1007/s12020-018-1615-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 04/21/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE This 2-year analysis assessed frequency of comorbidities and comorbidity screening in the Somatuline® (lanreotide, LAN) Depot for Acromegaly (SODA) registry. METHODS Patient data collected included pituitary hormone deficiencies, sleep studies, echocardiograms, gallbladder sonographies, colonoscopies, and glycated hemoglobin (HbA1c) levels. Insulin-like growth factor-1 (IGF-1) and growth hormone levels in patients with (DM) and without (non-DM) diabetes mellitus were analyzed. RESULTS There were 241 patients enrolled. Pituitary hormone deficiencies were reported more frequently at enrollment in male (56.9%) vs female patients (32.0%; p < 0.001). TSH deficiency was the most common endocrine deficiency (69.8%), followed by gonadotropin deficiency (62.3%). Screening tests reported at enrollment: sleep studies in 29.9% (79.2% had sleep apnea), echocardiogram in 46.1% (46.8% abnormal), gallbladder sonography in 18.7% (17.8% had gallstones), and colonoscopy in 48.1% (35.3% had polyps). Follow-up studies were reported less frequently at 1 and 2 years. HbA1c data were reported in 30.8% and 41.2% after 1 and 2 years. HbA1c levels were similar at 1 and 2 years of LAN therapy among DM and non-DM patients with available data. Fewer DM vs non-DM patients achieved IGF-1 below upper limit of normal at Month 24 (58.3% vs 80.6%; p = 0.033). CONCLUSIONS Fewer than half of patients in SODA had screening results reported at enrollment for sleep apnea, cardiomyopathy, and colon polyps. Gallbladder imaging was reported in a minority of patients. Lower IGF-1 control rates were observed in DM vs non-DM patients at Month 24. These data suggest a need for better monitoring of comorbidities in US acromegaly patients.
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Affiliation(s)
- Whitney W Woodmansee
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32610, USA.
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital/Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA.
| | - Murray B Gordon
- Allegheny Neuroendocrinology Center, Division of Endocrinology, Allegheny General Hospital, 420 E North Ave, Suite 205, Pittsburgh, PA, 15212, USA
| | - Mark E Molitch
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, 645 N. Michigan Avenue, Suite 530, Chicago, IL, 60611, USA
| | - Adriana G Ioachimescu
- Department of Medicine, Division of Endocrinology, Metabolism and Lipids, and Department of Neurosurgery, Emory University School of Medicine, 1365 B Clifton Rd, NE, B6209, Atlanta, GA, 30322, USA
| | - Don W Carver
- Ipsen Biopharmaceuticals statistician consultant, 106 Allen Road, Basking Ridge, NJ, 07920, USA
| | - Beloo Mirakhur
- Medical Affairs, Ipsen Biopharmaceuticals, Inc., 106 Allen Road, Basking Ridge, NJ, 07920, USA
| | - David Cox
- Medical Affairs, Ipsen Biopharmaceuticals, Inc., 106 Allen Road, Basking Ridge, NJ, 07920, USA
| | - Roberto Salvatori
- Division of Endocrinology, Diabetes and Metabolism and Pituitary Center, Johns Hopkins University, 1830 East Monument Street #333, Baltimore, MD, 21287, USA
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Xia Z, Guo X, Zhou Q, Wu J, Lian W, Yao Y, Deng K, Feng M, Wang R, Xing B. Somatotrophic Adenoma in Children Younger than 14 Years: Clinical Features and Treatment of 22 Cases at a Large Pituitary Center. World Neurosurg 2018; 112:e561-e568. [DOI: 10.1016/j.wneu.2018.01.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 12/17/2022]
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Freda PU, Gordon MB, Kelepouris N, Jonsson P, Koltowska-Haggstrom M, van der Lely AJ. Long-term treatment with pegvisomant as monotherapy in patients with acromegaly: experience from ACROSTUDY. Endocr Pract 2016; 21:264-74. [PMID: 25370326 DOI: 10.4158/ep14330.or] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate use of pegvisomant, a growth hormone (GH) receptor antagonist, as monotherapy in ACROSTUDY, a global safety surveillance study set in 14 countries (373 sites). METHODS A descriptive analysis of safety, magnetic resonance imaging (MRI) reading, and treatment outcomes in 710 subjects who received at least 1 pegvisomant dose as monotherapy during and up to 5 years follow-up in ACROSTUDY. RESULTS Subjects received a mean of 5.4 years of pegvisomant and were followed in ACROSTUDY for a mean of 3.8 years. A total of 1,255 adverse events (AEs) were reported in 345 subjects (48.6%). Serious AEs (SAEs) were reported in 133 (18.7%) subjects, including 22 deaths, none of which were attributed to pegvisomant use. Of 670 (94%) subjects with at least 1 liver function test (LFT) reported in ACROSTUDY, 8 (1.2%) had reported increases in transaminases >3 times the upper limit of normal (ULN). No liver failure was reported. Based on central MRI reading, 12 of 542 subjects (2.2%) had a confirmed increase or increase/decrease in tumor size. Injection-site reactions were reported in 2.3%. At 5 years of therapy, insulin-like growth factor 1 (IGF-1) level was reported normal in 67.5% (mean dose 17.2 mg/day) and elevated in 29.9% (mean dose 19.8 mg/day). Subjects on 20 mg per day or more rose from 36% at 3 years to 41% at 5 years of therapy. CONCLUSIONS ACROSTUDY data indicate that pegvisomant used as sole medical therapy is safe and effective for patients with acromegaly. The reported low incidence of pituitary tumor size increase and liver enzyme elevations are reassuring and support the positive benefit-risk of pegvisomant therapy.
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Affiliation(s)
- Pamela U Freda
- Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York
| | - Murray B Gordon
- Department of Medicine and Neurosurgery, Allegheny Neuroendocrinology Center, Allegheny General Hospital Pittsburgh, Pennsylvania
| | | | | | | | - A J van der Lely
- Department of Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
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Bernabeu I, Pico A, Venegas E, Aller J, Alvarez-Escolá C, García-Arnés JA, Marazuela M, Jonsson P, Mir N, García Vargas M. Safety of long-term treatment with Pegvisomant: analysis of Spanish patients included in global ACROSTUDY. Pituitary 2016; 19:127-37. [PMID: 26553421 DOI: 10.1007/s11102-015-0691-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To evaluate the long-term safety of Pegvisomant (PEG) in the Spanish cohort of ACROSTUDY. METHODS As of July 2013, 199 Spanish patients were included in ACROSTUDY, a global non interventional safety PEG surveillance study. Patients were observed for safety, biochemical outcome and magnetic resonance imaging evaluations. RESULTS PEG was administered during an average period of 6.7 ± 2.1 years and a mean daily dose of 15.5 ± 7.5 mg. 48.2% of patients received PEG monotherapy. 90.9% of patients had received other medical treatment before PEG start. 195 adverse events (AEs) were reported in 88 patients (44.2%), and serious AEs were described in 31 patients (15.6%). There were no cases of liver tests >10 ULN, or permanent liver damage. Tumor size changes were locally reported in 61 cases (33.5%), with increases observed in 11 patients (6%). In acromegalic patients with diabetes mellitus a decrease in fasting serum glucose value was reported, reaching statistical significance after 1 and 4 years of treatment (-24.6 and -25.9 mg/dl, p = 0.04). After 60 months, normal or lower limit of normal (LLN) IGF-I levels were found in 67.9% of patients. 85.5% of patients showed an IGF-I normal or <LLN at any time after PEG start. Most patients with uncontrolled IGF-I levels were on submaximal PEG doses. CONCLUSIONS ACROSTUDY carried out with the Spanish cohort confirmed that PEG has a favorable safety and efficacy profile. The percentage of patients considered under control was similar to data reported globally and in other local ACROSTUDY results.
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Affiliation(s)
- I Bernabeu
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - A Pico
- Hospital General Universitario de Alicante, Alicante, Spain.
| | - E Venegas
- Hospital Universitario Virgen del Rocío, Seville, Spain
| | - J Aller
- Hospital Universitario Puerta de Hierro - Majadahonda, Madrid, Spain
| | | | | | - M Marazuela
- Hospital Universitario de La Princesa, Madrid, Spain
| | - P Jonsson
- Pfizer Endocrine Care, Sollentuna, Sweden
| | - N Mir
- Pfizer Medical Department, Madrid, Spain
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Neggers SJCMM, Muhammad A, van der Lely AJ. Pegvisomant Treatment in Acromegaly. Neuroendocrinology 2016; 103:59-65. [PMID: 25792221 DOI: 10.1159/000381644] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/04/2015] [Indexed: 11/19/2022]
Abstract
Historically, medical treatment of acromegaly has mainly been used as an adjuvant therapy after surgery. In the last decades, an increased range of medical therapy options has been available. Somatostatin analogues have become the cornerstones of medical treatment in acromegaly and are even seen as a primary treatment in a selected group of acromegaly patients. The most recent medical treatment available for acromegaly patients is pegvisomant, a growth hormone receptor antagonist. To date, it is the most effective medical treatment, but it is costly. Pegvisomant is used as monotherapy and combined with somatostatin analogues. In this article, we review clinical studies and cohorts that have documented the efficacy of pegvisomant monotherapy and combined therapy and give a concise overview of associated side effects.
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Affiliation(s)
- Sebastian J C M M Neggers
- Section of Endocrinology, Department of Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
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9
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Sievers C, Baur DM, Schwanke A, Buchfelder M, Droste M, Mann K, Stalla GK. Prediction of therapy response in acromegalic patients under pegvisomant therapy within the German ACROSTUDY cohort. Pituitary 2015. [PMID: 26224528 DOI: 10.1007/s11102-015-0673-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE This study aimed at investigating predicting factors for therapy response under growth hormone receptor antagonist therapy with a focus on subjective and patient-oriented measures. METHODS Observational, multicenter nested-cohort study including 271 selected patients with the diagnosis of acromegaly and a minimum of one-year follow-up period within the German ACROSTUDY cohort (total cohort: n = 514). Outcome measures were the change of the biomarker IGF-1 (IGF-1 change and IGF-1 normalisation) between baseline and after 1 year of pegvisomant therapy (12 ± 6 months). Main predictors were patient-assessed subjective measures according to the Patient-Assessed Acromegaly Symptom Questionnaire (PASQ) in conjugation with age, gender, BMI, max. dosage of pegvisomant at follow-up and IGF-1 before the start of pegvisomant therapy. RESULTS The mean age of the study population was 51.2 (13.9) years and the mean BMI was 29.5 (5.1) kg/m(2). In adjusted analyses, none of the individual perceived health (PASQ) scores, but age, BMI and IGF-1 at baseline were predictive for an IGF-1 decrease after 1 year of pegvisomant therapy and BMI and IGF-1, but equally none of the PASQ items, were predicting IGF-1 normalisation. CONCLUSIONS Age, BMI and baseline IGF-1 but not subjective perceived health measures predict therapy response under second line medical therapy with pegvisomant.
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Affiliation(s)
- Caroline Sievers
- Clinical Neuroendocrinology, Clinical Research Department, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, 80804, Munich, Germany.
| | - Dorothee M Baur
- II Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Ismaningerstrasse 22, 81675, Munich, Germany
| | | | - Michael Buchfelder
- Department of Neurosurgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Klaus Mann
- Department of Endocrinology and Metabolism, University of Duisburg-Essen and Endokrinologiezentrum, Alter Hof, Munich, Germany
| | - Günter K Stalla
- Clinical Neuroendocrinology, Clinical Research Department, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, 80804, Munich, Germany
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Roelfsema F, van den Berg G. Diagnosis, treatment and clinical perspectives of acromegaly. Expert Rev Endocrinol Metab 2015; 10:619-644. [PMID: 30289037 DOI: 10.1586/17446651.2015.1096770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Acromegaly is an insidious disease of the pituitary caused by a growth hormone-secreting adenoma. Generally, the diagnosis is made rather late in the course of the disease. Currently, acromegaly can be cured in about half of the patients with the disease by expert surgery. The remainder of non-surgically cured patients often can be effectively treated with somatostatin analogs; either with the new generation of dopaminergic drugs or with Pegvisomant, a GH-receptor blocking agent. However, at the time of diagnosis many patients suffer from serious comorbidities, including hypertension, heart disease, arthrosis, sleep apnea and diabetes mellitus. Recent reports have shown that mortality risk can be normalized. Nevertheless, all efforts should be undertaken to treat comorbidities. New strategies for surgery and medical treatment are discussed.
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Affiliation(s)
- Ferdinand Roelfsema
- a Department of Endocrinology and Metabolism , Leiden University Medical Center , Leiden , The Netherlands
| | - Gerrit van den Berg
- b Department of Endocrinology and Metabolic Diseases, University Medical Center of Groningen , University of Groningen , Groningen , The Netherlands
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Grottoli S, Maffei P, Bogazzi F, Cannavò S, Colao A, Ghigo E, Gomez R, Graziano E, Monterubbianesi M, Jonsson P, De Marinis L. ACROSTUDY: the Italian experience. Endocrine 2015; 48:334-41. [PMID: 25150035 DOI: 10.1007/s12020-014-0393-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 08/11/2014] [Indexed: 11/28/2022]
Abstract
ACROSTUDY is a world-wide non-interventional, post marketing surveillance study performed to monitor the safety and outcomes of pegvisomant (PEG) in clinical practice. We report data from acromegaly patients who have been included in the Italian ACROSTUDY registry. The data of 341 acromegaly patients (171 males) were available for analysis using data freeze (12/9/2012). Patients were enrolled in 25 Italian endocrine centres. Before and during PEG treatment IGF-I, liver enzymes, metabolic parameters, and pituitary MRI were assessed. Before PEG, 54.3% patients had been treated with medical therapy and surgery, 22.9% medical therapy only, and 15.8% medical plus radiation and surgical therapy. 199 adverse events were reported in 98 patients (28.7%). Serious adverse events were documented in 29 patients (8.5%). 71.1% of patients had no significant change in tumor volume. Central MRI reading was performed in 34 patients; in 7 patients, an increase in tumor volume was found. Hormonal efficacy progressively increased since the start of PEG. After 6 years, normal IGF-I levels were found in 70.9% of patients (mean daily dose 18.1 mg). 87.1% of patients were treated with daily PEG although in 8.8% of patients, it was administered 2-6 times per week and in 3.8% with weekly injections. 74.8% received a PEG dose 10-15 mg/daily. PEG is a drug with a favorable safety profile which is efficacious also considering that in Italy it is currently available as third-line therapy.
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Affiliation(s)
- S Grottoli
- Divisione di Endocrinologia, Diabetologia e Metabolismo, Dipartimento di Scienze Mediche, AO Città della Salute e della Scienza di Torino, Università di Torino, C.so AM Dogliotti 14, 10126, Turin, Italy,
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Neggers SJCMM, Franck SE, de Rooij FWM, Dallenga AHG, Poublon RML, Feelders RA, Janssen JAMJL, Buchfelder M, Hofland LJ, Jørgensen JOL, van der Lely AJ. Long-term efficacy and safety of pegvisomant in combination with long-acting somatostatin analogs in acromegaly. J Clin Endocrinol Metab 2014; 99:3644-52. [PMID: 24937542 DOI: 10.1210/jc.2014-2032] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Treatment for acromegaly patients with long-acting somatotropin release-inhibiting factor (LA-SRIF) often does not result in complete normalization of IGF-1. Addition of pegvisomant (PEGV), a GH receptor antagonist, could improve this; however, the literature has not described long-term follow-up. OBJECTIVE To assess long-term efficacy and safety of this combined treatment in the largest current single-center cohort of patients, from 2004-2013. DESIGN Acromegaly patients were treated for at least 6 months with a high-dose LA-SRIF. To patients with persistently elevated IGF-1 levels (>1.2 × upper limit of normal) or poor quality of life, PEGV was added as one weekly injection. RESULTS The patients (n = 141) were treated with PEGV and LA-SRIFs for a median period of 4.9 years (range, 0.5-9.2). Efficacy, defined as the lowest measured IGF-1 level during treatment, was 97.0%. The median PEGV dose to achieve this efficacy was 80 mg weekly (interquartile range, 60-120 mg). Combination treatment-related adverse events were recorded in 26 subjects (18.4%). Pituitary tumor size increase was observed in one patient. Injection-site reactions were observed in four subjects. In 19 patients (13.5%), transiently elevated liver transaminases of more than three times the upper limit of normal were observed, of which 83% occurred within the first year of combination treatment. Eight patients died, at a mean age of 71 years; none of them were considered treatment-related. CONCLUSIONS The combination treatment with LA-SRIFs and PEGV was effective in 97% of the patients, it appears to be a safe medical treatment and it reduces the required dose of PEGV.
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Affiliation(s)
- S J C M M Neggers
- Department of Medicine, Endocrinology Section, Pituitary Center Rotterdam (S.J.C.M.M.N., S.E.F., R.A.F., J.A.M.J.L.J., L.J.H., A.J.v.d.L.), The Pituitary Center Rotterdam (S.J.C.M.M.N., A.H.G.D., R.M.L.P., R.A.F., J.A.M.J.L.J., L.J.H., A.J.v.d.L.), and Department of Medicine, Metabolism Section (F.W.M.d.R.), Erasmus University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; Department of Neurosurgery (M.B.), University Hospital Erlangen, 91054 Erlangen, Germany; and Medical Department (Endocrinology and Diabetes) (J.O.L.J.), Medical Research Laboratories, Clinical Institute, DK-8000 Aarhus C, Denmark
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13
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Fendri S, Karaca P, Tiev E, Buchfelder M, Lalau JD. Control of disease activity and tumor size after introduction of pegvisomant in a lanreotide-resistant acromegalic patient. ANNALES D'ENDOCRINOLOGIE 2013; 74:49-52. [PMID: 23337021 DOI: 10.1016/j.ando.2012.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 10/16/2012] [Indexed: 10/27/2022]
Abstract
We report on a 30-year-old female acromegalic patient treated with the growth hormone (GH) receptor antagonist pegvisomant at a low dose after the failure of long-acting lanreotide, neurosurgery and radiotherapy treatment to restore IGF-1 levels. The combination treatment was well tolerated and produced a dramatic improvement in the patient's condition (reduction in visual field defects, relief of headache and excessive perspiration), normalization of IGF-I levels and a considerable decrease in tumor size, enabling a dramatic decrease in lanreotide dosage and, ultimately, its withdrawal.
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Affiliation(s)
- Salha Fendri
- Service d'endocrinologie-nutrition, hôpital Sud, université Picardie-Jules-Verne, centre hospitalier universitaire, 80054 Amiens, France
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Bassareo PP, Marras AR, Mercuro G. Adolescent acromegaly and decreased arterial distensibility despite successful treatment. Clin Endocrinol (Oxf) 2012; 77:79-85. [PMID: 22182355 DOI: 10.1111/j.1365-2265.2011.04325.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Cardiovascular complications that are probably related to the loss of arterial elasticity, such as secondary hypertension, occur frequently in patients with acromegaly and may persist after the condition has been treated. The aim of the study was to determine arterial compliance in adolescent patients with acromegaly who had undergone surgery to remove the adenoma in the pituitary gland. This is thought to be the first study on such patients. PATIENTS Sixteen patients (nine male, seven female; mean age at diagnosis, 17·6 ± 1·3 years; mean age at time of study, 23·3 ± 3·7 years) who had undergone surgery for acromegaly that was caused by a pituitary adenoma. MEASUREMENTS Arterial stiffness was measured by the standardized noninvasive QKd(100-60) method. In addition, blood pressure at rest was measured, ambulatory blood pressure was monitored over a 24-h period and transthoracic echocardiography was performed. RESULTS Adolescent patients who had been operated upon for acromegaly showed disadvantageous differences in 24-h ambulatory blood pressure monitoring (systolic blood pressure, P < 0·001; diastolic blood pressure, P < 0·02; mean blood pressure, P < 0·01) and in QKd(100-60) value (194 ± 4 vs 205 ± 5 ms, P < 0·03) compared with controls. CONCLUSION Despite successful treatment, the patients showed significantly decreased arterial distensibility as compared with controls, which might explain the observed differences in blood pressure. The findings show that such patients are at increased risk of developing cardiovascular diseases, despite their being youth and the restoration of normal secretion of growth hormone/insulin growth factor.
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Affiliation(s)
- Pier P Bassareo
- Department of Cardiovascular and Neurological Sciences, University of Cagliari, Cagliari, Italy.
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Hubina E, Tóth A, Kovács GL, Dénes J, Kovács L, Góth M. [Growth hormone receptor antagonist in the treatment of acromegaly]. Orv Hetil 2011; 152:709-14. [PMID: 21498159 DOI: 10.1556/oh.2011.29101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Exploration of construction, function and interaction of human growth hormone and growth hormone receptor in details resulted in the innovation of the new growth hormone receptor antagonist, pegvisomant. Pegvisomant with different mechanism of action extended the tools of medical management of acromegaly. Importance of the novel treatment modality is high. In one hand the necessity of the strict control of growth hormone/insulin-like growth factor-I axis has been proven regarding the mortality of the disease. On the other hand, despite the use of all current modes of treatment (surgery, radiotherapy, dopamine agonists, somatostatin analogs), a significant cohort of patients with acromegaly remains inadequately controlled. Pegvisomant has been registered in 2004. Since 2006, it has been used in Hungary for the treatment of acromegaly in patients who have had an inadequate response to surgery and/or radiation therapy and/or other medical therapies, or for whom these therapies are not appropriate. Clinical use of pegvisomant in the treatment of acromegaly is effective, well tolerated, and safe, based on international Acrostudy database. In order to improve the efficacy of therapy clinical trials started with pegvisomant and somatostatin analog combination treatment. Evidence of several further effects of the growth hormone/insulin-like growth factor-I axis suggests other potential uses of growth hormone receptor antagonists.
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Affiliation(s)
- Erika Hubina
- Honvédkórház-Állami Egészségügyi Központ II. Belgyógyászati Osztály Budapest Podmaniczky u. 109-111. 1062.
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