title: Use of lanreotide in combination with cabergoline or pegvisomant in patients with acromegaly in the clinical practice: The ACROCOMB study.
abstract: OBJECTIVE
  To describe real-world use of lanreotide combination therapy for acromegaly.
  
  
  METHODS
  ACROCOMB is a retrospective observational Spanish study of patients with active acromegaly treated with lanreotide combination therapy between 2006 and 2011. 108 patients treated at 44 Spanish Endocrinology Departments were analyzed separately: 61 patients received lanreotide/cabergoline (cabergoline cohort) and 47 lanreotide/pegvisomant (pegvisomant cohort).
  
  
  RESULTS
  Patient median age was 50.8 years in the cabergoline cohort and 42.7 years in the pegvisomant cohort. Prior medical treatments were somatostatin analogue (SSA) monotherapy (40 [66%] patients) or dopamine agonists (7 [11%] patients) in the cabergoline cohort and SSA (29 [62%] patients) or pegvisomant monotherapy (16 [34%] patients) in the pegvisomant cohort. Across both cohorts 12 patients were previously untreated, and prior therapy was unknown/missing in 4 patients. Median duration of combined treatment was 1.6 years (0.1-6) and 2.1 years (0.4-6.3) in the cabergoline and pegvisomant cohorts, respectively. At baseline, median insulin growth factor (IGF)-I values were 149% upper limit of normal (ULN) (15-505%) in the cabergoline cohort and 156% ULN (15-534%) in the pegvisomant cohort, and decreased to 104% ULN (13-557%) p<0.001 and 86% ULN (23-345%) p<0.0001, respectively, at end of study (EOS). Normal age-adjusted values of IGF-I were obtained in 48% of lanreotide/cabergoline-treated patients and 70% of lanreotide/pegvisomant-treated patients at EOS. There were no significant changes in hepatic, cardiac or glycaemic parameters in either cohort.
  
  
  CONCLUSIONS
  In clinical practice lanreotide treatment combinations are useful options for patients with acromegaly when monotherapy is insufficient; particularly, the combination of lanreotide and pegvisomant in patients not controlled with either SSA or pegvisomant alone has high efficacy and is well-tolerated.
authors.affiliation: Hospital Universitario Germans Trias i Pujol, Carretera Canyet, s/n 08916 Badalona, Barcelona, Spain. Electronic address: mpuigd@igtp.cat.
authors.forename: Manuel
authors.initials: M
authors.lastname: Puig-Domingo
authors.affiliation: Hospital Universitario Virgen del Rocío, Av Manuel Siurot, 0, 41013 Sevilla, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Soto
authors.affiliation: Hospital Universitario Virgen del Rocío, Av Manuel Siurot, 0, 41013 Sevilla, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Venegas
authors.affiliation: Hospital Universitario Virgen de las Nieves, Av de las Fuerzas Armadas, 2, 18014 Granada, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Vilchez
authors.affiliation: Hospital Universitario Príncipe de Asturias, Carretera Alcalá-Meco, s/n, 28805 Alcalá de Henares, Madrid, Spain.
authors.forename: Concepción
authors.initials: C
authors.lastname: Blanco
authors.affiliation: Hospital Universitario A Coruña, As Xubias, 84, 15006 A Coruña, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Cordido
authors.affiliation: Hospital Universitario Puerta de Hierro, Calle Manuel de Falla, 1, 28222 Majadahonda, Madrid, Spain.
authors.forename: Tomás
authors.initials: T
authors.lastname: Lucas
authors.affiliation: Hospital Universitario La Princesa, Calle de Diego León, 62, 28006 Madrid, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Marazuela
authors.affiliation: Hospital Lluis Alcanyís, Carretera Xàtiva-Silla, km 2, 46800 Xàtiva, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Casany
authors.affiliation: Centro Médico Teknon, Carrer de Vilana, 12, 08022 Barcelona, Spain.
authors.forename: Guillem
authors.initials: G
authors.lastname: Cuatrecasas
authors.affiliation: Hospital Universitario La Ribera, Carretera Corbera, km 1, 46600 Alzira, Valencia, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Fajardo
authors.affiliation: Hospital Universitario Reina Sofía, Avda. Menéndez Pidal, s/n, 14004 Córdoba, Spain.
authors.forename: María Ángeles
authors.initials: MÁ
authors.lastname: Gálvez
authors.affiliation: Hospital Clínico Universitario Virgen de la Victoria, Campus Universitario de Teatinos, s/n, 29010, Málaga, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Maraver
authors.affiliation: Hospital Universitario Virgen Macarena, Avd. Dr. Fedriani, 3, 41007 Sevilla, Spain.
authors.forename: Tomás
authors.initials: T
authors.lastname: Martín
authors.affiliation: Hospital Clínico Universitario, Av Ramón y Cajal, 3, 47005 Valladolid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Romero
authors.affiliation: Hospital Universitario de Basurto, Avda. de Montevideo N° 18, (Carretera N-634), 48013 Bilbao, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Paja
authors.affiliation: Hospital General Universitario de Alicante, Av Pintor Baeza, 12, 03010 Alicante, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Picó
authors.affiliation: Hospital Clínico Universitario, Travesía de Choupana, s/n, 15706 Santiago de Compostela, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Bernabeu
authors.affiliation: Endocrinología, Hospital Sant Pau, Pare Claret, 167, Barcelona, Spain.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Resmini
mesh_terms: D000172:Acromegaly / Q000188:drug therapy*; D000077465:Cabergoline; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000009:adverse effects*; D004873:Ergolines / Q000008:administration & dosage / Q000737:chemistry / Q000494:pharmacology*; D019382:Human Growth Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis / Q000737:chemistry / Q000378:metabolism*; D010456:Peptides, Cyclic / Q000008:administration & dosage / Q000737:chemistry / Q000494:pharmacology*; D012189:Retrospective Studies; D013004:Somatostatin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000737:chemistry / Q000494:pharmacology
chemical_list: D018491:Dopamine Agonists; D004873:Ergolines; D010456:Peptides, Cyclic; C060347:lanreotide; D019382:Human Growth Hormone; D013004:Somatostatin; D007334:Insulin-Like Growth Factor I; D000077465:Cabergoline; C406545:pegvisomant
keywords: Acromegalia; Acromegaly; Análogos de la somatostatina; Cabergolina; Cabergoline; IGF-I; Lanreotida; Lanreotide; Pegvisomant; Somatostatin analogues