title: Pegvisomant and cabergoline combination therapy in acromegaly.
abstract: Combination with cabergoline may offer additional benefits to acromegalic patients on pegvisomant monotherapy. We evaluated the safety and efficacy profile of this combination and investigated the determinants of response. An observational, retrospective, cross-sectional study. Fourteen acromegalic patients (9 females), who were partially resistant to somatostatin analogs and on pegvisomant monotherapy. Cabergoline was added because of the presence of persistent mildly increased IGF-I. The mean follow-up time was 18.3 ± 10.4 months. The efficacy and safety profile was assessed. The influence of clinical and biochemical characteristics on treatment efficacy was studied. IGF-I levels returned to normal in 4 patients (28%) at the end of the study. In addition, some decline in IGF-I levels was observed in a further 5 patients. The % IGF-I decreased from 158 ± 64% to 124 ± 44% (p = 0.001). The average change in IGF-I was -18 ± 27% (range -67 to +24%). Lower baseline IGF-I (p = 0.007), female gender (p = 0.013), lower body weight (p = 0.031), and higher prolactin (PRL) levels (p = 0.007) were associated with a better response to combination therapy. There were no significant severe adverse events. Significant tumour shrinkage was observed in 1 patient. Combination therapy with pegvisomant and cabergoline could provide better control of IGF-I in some patients with acromegaly. Baseline IGF-I levels, female gender, body weight, and PRL levels affect the response to this combination therapy.
authors.affiliation: Endocrinology Department, Complejo Hospitalario Universitario de Santiago de Compostela (SERGAS), Travesía de la Choupana s/n, 15706, Santiago de Compostela, Spain. ignacio.bernabeu.moron@sergas.es
authors.forename: I
authors.initials: I
authors.lastname: Bernabeu
authors.forename: C
authors.initials: C
authors.lastname: Alvarez-Escolá
authors.forename: A E
authors.initials: AE
authors.lastname: Paniagua
authors.forename: T
authors.initials: T
authors.lastname: Lucas
authors.forename: I
authors.initials: I
authors.lastname: Pavón
authors.forename: J M
authors.initials: JM
authors.lastname: Cabezas-Agrícola
authors.forename: F F
authors.initials: FF
authors.lastname: Casanueva
authors.forename: M
authors.initials: M
authors.lastname: Marazuela
mesh_terms: D000172:Acromegaly / Q000188:drug therapy*; D000328:Adult; D000077465:Cabergoline; D004359:Drug Therapy, Combination; D004873:Ergolines / Q000627:therapeutic use*; D005260:Female; D019382:Human Growth Hormone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D004873:Ergolines; D019382:Human Growth Hormone; D000077465:Cabergoline; C406545:pegvisomant