title: Combination treatment with somatostatin analogues and pegvisomant in acromegaly.
abstract: Mono-therapy using long-acting somatostatin analogues and surgery cannot provide optimal biochemical control in a large proportion of patients with acromegaly. This results in increased mortality, poor control of signs and symptoms of disease and decreased quality of life. Combined treatment with somatostatin analogues and pegvisomant (a growth-hormone-receptor antagonist) seems to be an attractive option. Combination treatment is highly effective at normalising the level of insulin-like growth factor 1 in over 90% of patients and has a favourable effect on quality of life in those with biochemically controlled acromegaly. Moreover, combination therapy with somatostatin analogues results in a clinically relevant decrease in tumour size in about 20% of patients, whereas pegvisomant (PEG-V) mono-therapy does not decrease pituitary tumour size. Transient elevations in the levels of transaminases are the main adverse effects of combination treatment, which occur in about 11-15% of patients.
authors.affiliation: Department of Medicine, Section Endocrinology, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands. s.neggers@erasmusmc.nl
authors.forename: S J C M M
authors.initials: SJ
authors.lastname: Neggers
authors.forename: A J
authors.initials: AJ
authors.lastname: van der Lely
mesh_terms: D000172:Acromegaly / Q000188:drug therapy* / Q000209:etiology; D004359:Drug Therapy, Combination / Q000379:methods; D006727:Hormone Antagonists / Q000627:therapeutic use*; D019382:Human Growth Hormone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008111:Liver Function Tests; D010911:Pituitary Neoplasms / Q000150:complications / Q000188:drug therapy; D011788:Quality of Life; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D000637:Transaminases / Q000378:metabolism
chemical_list: D006727:Hormone Antagonists; D019382:Human Growth Hormone; D013004:Somatostatin; D000637:Transaminases; C406545:pegvisomant