Pegvisomant in acromegaly: an update.
BACKGROUND
In 2007, we published an opinion document to review the role of pegvisomant (PEG) in the treatment of acromegaly. Since then, new evidence emerged on the biochemical and clinical effects of PEG and on its long-term efficacy and safety.


OBJECTIVE
We here reviewed the emerging aspects of the use of PEG in clinical practice in the light of the most recent literature.


RESULTS
The clinical use of PEG is still suboptimal, considering that it remains the most powerful tool to control IGF-I in acromegaly allowing to obtain, with a pharmacological treatment, the most important clinical effects in terms of signs and symptoms, quality of life and comorbidities. The number of patients with acromegaly exposed to PEG worldwide has become quite elevated and the prolonged follow-up allows now to deal quite satisfactorily with many clinical issues including major safety issues, such as the concerns about possible tumour (re)growth under PEG. The positive or neutral impact of PEG on glucose metabolism has been highlighted, and the clinical experience, although limited, with sleep apnoea and pregnancy has been reviewed. Finally, the current concept of somatostatin receptor ligands (SRL) resistance has been addressed, in order to better define the acromegaly patients to whom the PEG option may be offered.


CONCLUSIONS
PEG increasingly appears to be an effective and safe medical option for many patients not controlled by SRL but its use still needs to be optimized.
Chair of Endocrinology, Vita-Salute San Raffaele University, Milano, Italy. a.giustina@libero.it.
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A
Giustina
Clinic of Endocrinology and Metabolism Disease, Ospedali Riuniti di Ancona, Ancona, Italy.
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G
Arnaldi
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
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Bogazzi
Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
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S
Cannavò
Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
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A
Colao
Pituitary Unit, Catholic University School of Medicine, Rome, Italy.
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De Marinis
Department of Internal Medicine, General Hospital, Montebelluna (TV), Italy.
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De Menis
Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
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Degli Uberti
Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy.
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F
Giorgino
Endocrinology, Diabetology and Metabolism, AOU Città della Salute e della Scienza of Turin, Turin, Italy.
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Grottoli
Endocrinology Unit, Department of Biomedical Sciences, Humanitas University and Humanitas Research Hospital, Rozzano, Italy.
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Lania
Department of Medicine (DIMED), 3rd Medical Clinic, Azienda Ospedaliera Padova, Padova, Italy.
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Maffei
Department of Clinical and Surgery Medicine, Endocrinology and Metabolism, University of Naples, Naples, Italy.
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R
Pivonello
Department of Medical Sciences, School of Medicine, University of Turin, Turin, Italy.
E
E
Ghigo
D000172:Acromegaly / Q000188:drug therapy*; D000818:Animals; D019382:Human Growth Hormone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans
D019382:Human Growth Hormone; C406545:pegvisomant
Acromegaly; IGF-I; Metabolic effects; Pegvisomant; Review; SRL resistance