New formulations and approaches in the medical treatment of acromegaly.
OBJECTIVE
To discuss novel drug formulations being developed for the medical treatment of acromegaly and to highlight recent data from studies reporting more effective therapeutic strategies using existing drugs.


RESULTS
Despite advances in the management of acromegaly a significant number of patients remain uncontrolled. Primary medical treatment is being increasingly considered, but use of somatostatin analogues, the current mainstay of medical therapy, achieves control in only around 60% of patients, whilst 10-20% may be controlled with dopamine agonists. Consequently, improvements in drug efficacy and convenience are needed. Newer longer-acting somatostatin analogues are in development and combination regimes with the growth hormone receptor antagonist, pegvisomant, given at more cost-effective weekly doses show promising results. Somatostatin analogue-resistant tumours may respond to ligands with higher affinities to other receptors, such as pasireotide (SOM 230). Further, the combined dopamine/somatostatin receptor analogue BIM-23A760 has increased affinity to somatostatin receptors 2 and 5 and to the dopamine 2 receptor, and phase 2 clinical studies are underway.


CONCLUSIONS
These novel drugs, formulations and treatment regimes should potentially add to the armamentarium of treatment options for patients with acromegaly.
Debono
Miguel
M
Academic Unit of Endocrinology, Department of Human Metabolism, University of Sheffield, Beech Hill Road, Sheffield, UK.
Newell-Price
John
J
D000172:Acromegaly / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D000236:Adenoma / Q000150:complications / Q000188:drug therapy / Q000378:metabolism; D002626:Chemistry, Pharmaceutical / Q000639:trends*; D004305:Dose-Response Relationship, Drug; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000150:complications / Q000188:drug therapy / Q000378:metabolism; D006727:Hormone Antagonists / Q000008:administration & dosage / Q000138:chemical synthesis / Q000627:therapeutic use*; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors
D006727:Hormone Antagonists; D019382:Human Growth Hormone; D013004:Somatostatin