Emerging drugs for acromegaly.
BACKGROUND
Acromegaly is due to growth hormone (GH) hypersecretion by a benign pituitary tumor (adenoma). Treatments include surgical removal of the adenoma (often incomplete when the tumor is large and/or invasive), radiotherapy of the pituitary region (sometimes effective only after > 10 years, and potentially causing cerebrovascular disease), and medical therapy.


METHODS
The scope of this article is to review the efficacy and safety of currently marketed drugs and to discuss the interest of new compounds. For this purpose, critical analysis of original articles and reviews was made and manufacturers were asked to provide all data that have been presented in congress and are not yet published.


CONCLUSIONS
Somatostatin analogs (first octreotide and then lanreotide) have been used for 20 years to treat patients in whom surgery and/or radiotherapy has failed, and also as first-line therapy when other modalities are contraindicated or are unlikely to control GH and insulin-like growth factor-I (IGF-I) hypersecretion. Long-lasting formulations, requiring only one monthly injection, have greatly improved the convenience of these treatments. GH/IGF-I hypersecretion is controlled by these drugs in about 50% of patients, but the remaining patients require another treatment. Pegvisomant, a drug belonging to a totally different therapeutic class (GH-receptor antagonists) with a different mode of action, is effective in most of these patients. According to current research goals, new developmental drugs include new somatostatin analogs (SAs) with different somatostatin receptor selectivity, and chimeric molecules that are able to bind to both somatostatin and dopamine receptors.
Service d'Endocrinologie et des Maladies de la Reproduction, Hôpital de Bicêtre, 78 rue du Général Leclerc, F-94275 Le Kremlin-Bicêtre, France. philippe.chanson@bct.aphp.fr
Philippe
P
Chanson
D000172:Acromegaly / Q000188:drug therapy*; D016503:Drug Delivery Systems; D015195:Drug Design; D019382:Human Growth Hormone / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; 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
D010456:Peptides, Cyclic; C060347:lanreotide; D019382:Human Growth Hormone; D013004:Somatostatin; C406545:pegvisomant; D015282:Octreotide