title: Combined therapy with somatostatin analogues and weekly pegvisomant in active acromegaly.
abstract: Pegvisomant monotherapy once daily returns concentrations of insulin-like growth factor I (IGF-I) to normal in most patients with acromegaly, but is very costly. In a 42-week dose-finding study, we assessed the efficacy of the combination of long-acting somatostatin analogues once monthly and pegvisomant once weekly in 26 patients with active acromegaly. Dose of pegvisomant was increased until IGF-I concentration became normal or until a weekly dose of 80 mg was reached. IGF-I reached normal concentrations in 18 of 19 (95%) patients who completed 42 weeks of treatment, with a median weekly dose of 60 mg pegvisomant (range 40-80). No signs of pituitary tumour growth were noted, but mild increases in liver enzymes were observed in ten patients (38%). This combined treatment is effective, might increase compliance, and could greatly reduce the costs of medical treatment for acromegaly in some patients.
authors.affiliation: Department of Internal Medicine, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Feenstra
authors.forename: W W
authors.initials: WW
authors.lastname: de Herder
authors.forename: S M T H
authors.initials: SM
authors.lastname: ten Have
authors.forename: A W
authors.initials: AW
authors.lastname: van den Beld
authors.forename: R A
authors.initials: RA
authors.lastname: Feelders
authors.forename: J A M J L
authors.initials: JA
authors.lastname: Janssen
authors.forename: A J
authors.initials: AJ
authors.lastname: van der Lely
mesh_terms: D000172:Acromegaly / Q000097:blood / Q000188:drug therapy*; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D003692:Delayed-Action Preparations; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D019382:Human Growth Hormone / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage*; D010456:Peptides, Cyclic / Q000008:administration & dosage*; D011986:Receptors, Somatotropin / Q000037:antagonists & inhibitors*; D013004:Somatostatin / Q000008:administration & dosage* / Q000031:analogs & derivatives*
chemical_list: D003692:Delayed-Action Preparations; D010456:Peptides, Cyclic; D011986:Receptors, Somatotropin; C060347:lanreotide; D019382:Human Growth Hormone; D013004:Somatostatin; D007334:Insulin-Like Growth Factor I; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; C406545:pegvisomant; D015282:Octreotide