Long-term effects of pegvisomant in patients with acromegaly.
Despite improved surgical and radiotherapy techniques and the development of long-acting somatostatin analogs, some patients with acromegaly cannot attain biochemical remission. As a consequence they continue to endure debilitating symptoms and mortality remains high. Pegvisomant, a recombinant growth-hormone-receptor antagonist, suppresses production of insulin-like growth factor I. Since the introduction of this drug several years ago, long-term studies involving hundreds of patients have established efficacy of more than 85%. Raised transaminase concentrations have, however, been reported as a side effect of therapy, albeit an infrequent one. In addition, increases in tumor volume have been reported in several cases. In this Review we present the long-term data that have been gathered on pegvisomant therapy, discuss the related risks and benefits, and frame a potential therapeutic approach.
Hodish
Israel
I
Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan Medical Center and the Veterans' Affairs Medical Center, Ann Arbor, MI, USA.
Barkan
Ariel
A
D000172:Acromegaly / Q000188:drug therapy* / Q000503:physiopathology; D001842:Bone and Bones / Q000378:metabolism; D004359:Drug Therapy, Combination; D005947:Glucose / Q000378:metabolism; D006321:Heart / Q000503:physiopathology; D019382:Human Growth Hormone / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008055:Lipids / Q000097:blood; D008099:Liver / Q000187:drug effects; D010911:Pituitary Neoplasms / Q000139:chemically induced / Q000473:pathology; D011986:Receptors, Somatotropin / Q000037:antagonists & inhibitors*
D008055:Lipids; D011986:Receptors, Somatotropin; D019382:Human Growth Hormone; D005947:Glucose; C406545:pegvisomant