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  • Review Article
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Somatostatin analog and pegvisomant combination therapy for acromegaly

Abstract

Optimal biochemical control cannot be attained by long-acting somatostatin analog monotherapy in a large proportion of patients with acromegaly. Such therapy might result in increased mortality, poor control of signs and symptoms of disease and decreased quality of life. Combination treatment with somatostatin analogs and pegvisomant (a growth-hormone-receptor antagonist) is, however, highly effective at normalizing the level of insulin-like growth factor I in over 90% of patients and might also have a favorable effect on quality of life in those with biochemically controlled acromegaly. Moreover, whereas pegvisomant monotherapy does not lead to a decrease in the size of the pituitary tumor, combination therapy with somatostatin analogs results in a clinically relevant decrease in tumor size in about 20% of patients. The main adverse effects of combination treatment are transient elevations in the levels of transaminases, which occur in about 15% of patients, especially in those with diabetes mellitus. In this Review, we discuss the available data on the long-term efficacy and safety of somatostatin analog–pegvisomant combination treatment and its potential use in patients with acromegaly.

Key Points

  • Combination therapy for acromegaly with somatostatin analogs and pegvisomant has at least the same efficacy as pegvisomant alone, but enables reduced doses of pegvisomant to be used

  • Control of tumor size is established in all patients in response to combination therapy, and some tumors even decrease in size

  • Combination therapy seems to improve quality of life in patients who have already achieved biochemical control of acromegaly in response to monotherapy with somatostatin analogs

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Figure 1: Ligand binding to the growth-hormone receptor.
Figure 2: The relationship between baseline IGF-I level and the required dose of pegvisomant.
Figure 3: Elevated levels of liver enzymes during somatostatin analog–pegvisomant combination therapy.

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Correspondence to Sebastian J. C. Neggers.

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Competing interests

A. J. van der Lely is a consultant for Ipsen Pharma International, Novartis Pharma and Pfizer International; he has received travel support from Novartis Pharma and Pfizer International.

S. J. C Neggers declares no competing interests.

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Neggers, S., van der Lely, A. Somatostatin analog and pegvisomant combination therapy for acromegaly. Nat Rev Endocrinol 5, 546–552 (2009). https://doi.org/10.1038/nrendo.2009.175

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