The use of a GH receptor antagonist in patients with acromegaly resistant to somatostatin analogs.
Pegvisomant, a GH receptor antagonist, is a new pharmaceutical approach to acromegaly. It enables IGF-I levels to return in the age- and sex-reference range in approximately 90% of patients. This new approach is particularly beneficial in those patients who do not experience control of hormone hypersecretion after surgery and/or medical treatment with somatostatin analogs. In our preliminary experience, out of 16 patients unsuccessfully operated on by transsphenoidal surgery and resistant to 40-mg octreotide-LAR or 120-mg lanreotide for at least 6 months, 13 normalized their IGF-I levels within 6 months from treatment beginning. Normalization of IGF-I levels was accompanied by a significant decrease of ring size. We did not observe any increase of tumor remnant in this short period of treatment. In two cases we observed a significant increase of liver transaminases levels. In conclusion, more than 80% of patients with acromegaly unsuccessfully treated by surgery or currently available somatostatin analogs can achieve normal IGF-I levels after short-term treatment with pegvisomant.
Colao
A
A
Departments of Molecular and Clinical Endocrinology and Oncology, Federico II University, Naples, Italy. colao@unina.it
Pivonello
R
R
Cappabianca
P
P
Auriemma
R S
RS
De Martino
M C
MC
Ciccarelli
A
A
de Divitiis
E
E
Lombardi
G
G
D000172:Acromegaly / Q000188:drug therapy*; D000328:Adult; D005260:Female; D006727:Hormone Antagonists / Q000627:therapeutic use*; D019382:Human Growth Hormone / Q000031:analogs & derivatives* / Q000097:blood / Q000378:metabolism* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008565:Membrane Proteins / Q000037:antagonists & inhibitors* / Q000378:metabolism; D008875:Middle Aged; D015282:Octreotide / Q000494:pharmacology / Q000627:therapeutic use; D010456:Peptides, Cyclic / Q000494:pharmacology / Q000627:therapeutic use; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use
D006727:Hormone Antagonists; D008565:Membrane Proteins; D010456:Peptides, Cyclic; C405010:delta-hGHR; C060347:lanreotide; D019382:Human Growth Hormone; D013004:Somatostatin; C406545:pegvisomant; D015282:Octreotide