title: Combined treatment of somatostatin analogues with pegvisomant in acromegaly.
abstract: Treatment of acromegaly with monotherapy long-acting somatostatin analogues (LA-SSA) as primary treatment or after neurosurgery can only achieve complete normalization of insulin-like growth factor I (IGF-I) in roughly 40 % of patients. Recently, one of the acromegaly consensus groups has recommended switching to combined treatment of LA-SSA and pegvisomant (PEGV) in patients with partial response to LA-SSAs. This combination of LA-SSA and PEGV, a growth hormone receptor antagonist, can normalize IGF-I levels in virtually all patients, requiring that the adequate dose of PEGV is used. The required PEGV dose varies significantly between individual acromegaly patients. One of the advantages of the combination therapy is that tumor size control or even tumor shrinkage can be observed in a vast majority of patients. The main side effects of the combination treatment are gastrointestinal symptoms, lipohypertrophy and transient elevated liver transaminases. In this review we provide an overview of the efficacy and safety of the combined treatment of LA-SSAs with PEGV.
authors.affiliation: Department of Internal Medicine, Endocrinology Section, Pituitary Center Rotterdam, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. s.franck@erasmusmc.nl.
authors.forename: S E
authors.initials: SE
authors.lastname: Franck
authors.affiliation: Department of Internal Medicine, Endocrinology Section, Pituitary Center Rotterdam, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Muhammad
authors.affiliation: Department of Internal Medicine, Endocrinology Section, Pituitary Center Rotterdam, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: van der Lely
authors.affiliation: Department of Internal Medicine, Endocrinology Section, Pituitary Center Rotterdam, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
authors.forename: S J C M M
authors.initials: SJ
authors.lastname: Neggers
mesh_terms: D000172:Acromegaly / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D019382:Human Growth Hormone / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D009929:Organ Size / Q000187:drug effects; D010902:Pituitary Gland / Q000187:drug effects; D011788:Quality of Life; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D019382:Human Growth Hormone; D013004:Somatostatin; C406545:pegvisomant
keywords: Acromegaly; Growth hormone; Growth hormone receptor antagonist; Insulin-like growth factor I; Pegvisomant; Somatostatin analogues