ECE2011 Poster Presentations Pituitary (111 abstracts)
Pegvisomant therapy in acromegaly: a multicenter observational study
A Bianchi 1 , L Tilaro 1 , F Valentini 2 , P Gargiulo 3 , M Poggi 4 , R Baldelli 5 , M Passeri 6 & L De Marinis 1
1School of Medicine, Endocrinology, Catholic University, Rome, Italy; 2S.Camillo-Forlanini Hospital, Endocrinoogy, Rome, Italy; 3University ‘La Sapienza’, Endocrinology, Rome, Italy; 4University ‘La Sapienza’, Second Faculty, Endocrinology, Rome, Italy; 5Regina Elena national Cancer Institute, Endocrinoogy, Rome, Italy; 6University for Vergata, Endocrinology, Rome, Italy.
Patients with acromegaly resistant to conventional drug treatment currently can advantage with GH-receptor antagonist pegvisomant. To date, at doses up to 40 mg/day, it is capable of normalizing circulating IGF1 in until 97% of patients. Here we present the multicenter experience in Rome with Pegvisomant as a therapeutic option in acromegaly. This is an observational study including a total of 61 patients (21 males and 40 females) treated with pegvisomant for up to 7 years. Of all patients, 59 were reported to have had surgery and 17 to have received radiation therapy; 57 had received somatostatin analogues. Before starting Pegvisomant, all patients had IGF1 values above the upper limit of age and sexadjusted normal range. A total of 53 patients (87%) normalized the IGF1 value on pegvisomant therapy. A transitory increase of liver enzymes was observed in 7 (11.5%) patients and completely resolved after temporary stopping of pegvisomant. In 2 patients we observed adverse reaction at the injection site. No patient had an increase of the tumor volume at pituitary magnetic resonance imaging and, in 1 case, control MRI documented a gradual decrease of pituitary adenoma which disappeared after 6 years of treatment with pegvisomant, without other pharmacological association. In 2 cases, the treatment with at 10 mg daily dose induced an excessive reduction of IGF1 with onset of severe fatigue and diffuse myalgia, suddenly and significantly improved in both patients after alternate-day administration. Our experience indicates that pegvisomant is a safe and effective treatment in acromegaly and that it is well-tolerated. However, caution should be taken in starting treatment at the lowest dose and accurately monitoring IGF1 levels 4/6 weeks after the initiation of pegvisomant. Moreover, it is necessary to carefully consider all new symptoms manifested by patients treated with pegvisomant.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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