ICEECE2012 Poster Presentations Pituitary Clinical (183 abstracts)
Pegvisomant and cabergoline combination therapy in acromegaly
I Bernabeu 1 , C Alvarez-Escola 2 , A Paniagua 3 , T Lucas 4 , I Pavon 5 , J Cabezas Agricola 1 , F Casanueva 1 & M Marazuela 6
1Hospital Clinico Universitario Santiago de Compostela, La Coruña, Spain; 2Hospital Universitario La Paz, Madrid, Spain; 3Hospital Infanta Cristina, Parla, Madrid, Spain; 4Hospital Universitario Puerta de Hierro- Majadahonda, Madrid, Spain; 5Hospital Universitario de Getafe, Getafe, Madrid, Spain; 6Hospital Universitario La Princesa, Madrid, Spain.
Objective: Combination with cabergoline may offer additional benefits to acromegalic patients on pegvisomant monotherapy. We evaluated the safety and efficacy profile of this combination and investigated the determinants of response.
Design: An observational, retrospective, cross-sectional, registry-based study.
Patients and methods: Fourteen acromegalic patients (9 females), who were partially resistant to somatostatin analogs and on pegvisomant monotherapy. Cabergoline was added because of the presence of persistent increased IGF1. The mean follow up time was 18.3±10.4 months. The efficacy and safety profile was assessed. The influence of clinical, biochemical, and histological characteristics on treatment efficacy was studied.
Results: IGF1 levels returned to normal in 4 patients (28%) at the end of the study. In addition, some decline in IGF1 levels was observed in a further 5 patients. The % IGF1 decreased from 158±64% to 124±44% (P=0.001). The average change in IGF1 was −18±27% (range −67 to 24%). Lower baseline IGF1 (P=0.007), female gender (P=0.013), lower body weight (P=0.031), higher prolactin (PRL) levels (P=0.007), and positive tumour PRL immunostaining (P=0.029) were associated with a better response to combination therapy. There were no significant severe adverse events. Significant tumour shrinkage was observed in 1 patient.
Conclusions: Combination therapy with pegvisomant and cabergoline could provide better control of IGF1 in patients with acromegaly. Baseline IGF1 levels, female gender, body weight, PRL levels, and PRL immunostaining affect the response to this combination therapy.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This work was supported, however funding details unavailable.
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Endocrine Abstracts
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