ECE2013 Poster Presentations Pituitary – Clinical (<emphasis role="italic">Generously supported by IPSEN</emphasis>) (127 abstracts)
Prevalence of escape and lipodystrophy in patients treated with Pegvisomant. A multicenter study
Gemma Sesmilo 1 , Eugenia Resmini 2 , Ignacio Bernabeu 3 , Javier Aller 4 , Alfonso Soto 5 , Mónica Marazuela 6 , Mireia Mora 7 , Antonio Picó 8 , Carmen Fajardo 9 , Elena Torres 10 , Cristina Álvarez-Escolá 11 , Rogelio García-Centeno 12 , Concepción Blanco 13 , Rosa Cámara 14 , Sonia Gaztambide 15 , Isabel Salinas 16 , Carlos Del Pozo 17 , Ignasi Castells 18 , Carles Villabona 19 & Susan Webb 2
1Servicio Endocrinología, Institut Universitari Dexeus, Barcelona, Spain; 2IIB- Sant Pau y Servicio de Endocrinología, Departamento de Medicina y Centro de Investigación Biomédica en Enfermedades Raras (CIBER-ER Unidad 747), Hospital Sant Pau, Universitat Autònoma de Barcelo, Barcelona, Spain; 3Servicio de Endocrinología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain; 4Servicio de Endocrinología. Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain; 5Servicio de Endocrinología, Hospital Universitario Virgen del Rocío, Sevilla, Spain; 6Servicio de Endocrinología, Hospital Universitario de La Princesa, Madrid, Spain; 7Servicio de Endocrinología, Hospital Clínic, Barcelona, Spain; 8Servicio de Endocrinología, Hospital General de Alicante, Alicante, Spain; 9Servicio de Endocrinología, Hospital de la Ribera, Valencia, Spain; 10Servicio de Endocrinología, Hospital Universitario San Cecilio, Granada, Spain; 11Servicio de Endocrinología, Hospital Universitario la Paz, Madrid, Spain; 12Servicio de Endocrinología, Hospital Gregorio Marañón, Madrid, Spain; 13Servicio de Endocrinología, Hospital Príncipe de Asturias, Madrid, Spain; 14Servicio de Endocrinología, Hospital La Fe, Valencia, Spain; 15Servicio de Endocrinología, Hospital de Cruces, Baracaldo, Spain; 16Servicio de Endocrinología, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain; 17Servicio de Endocrinología, Hospital Mutua de Terrassa, Barcelona, Spain; 18Servicio de Endocrinología, Hospital de Granollers, Barcelona, Spain; 19Servicio de Endocrinología, Hospital de Bellvitge, Barcelona, Spain.
Pegvisomant (peg) is an effective treatment for acromegaly.
Aim: To investigate the prevalence of escape and the incidence of lipodystrophy with peg treatment.
Methods: Multicenter retrospective study. Escape was defined as loss of control in patients previously controlled under a stable dose of peg, without any other treatment change. Lipodystrophy was defined as either hypertrophy or atrophy of subcutaneous tissue in areas of drug administration.
Results: Ninety-eight patients were included (59% women, mean age at diagnosis 42±13 years, 80% macroadenomas). Ninety-two percent achieved normal IGF-1 on peg. Escape was reported in 33/90 (37%) of responders. Mean time on peg before escape was 22±20 months. The mean initial dose was 11±3 mg/day and mean dose at escape was 14±7 mg/day. Most patients: 30/33 (91%) achieved control with dose increase (57%), medical treatment addition (13%) or both (27%); in one case, escape was temporary. Treatments associated were cabergoline in 50% somatostatin analogs in 45% and both in 5%. Mean new dose that controlled IGF-1 after escape was 19±8 mg/day. Lipohypertrophy was observed in 14 patients (14.4%) whereas lipoatrophy was observed in one (1%). Lipohypertrophy developed in the abdominal wall in four, arms in two, thighs in four and in multiple sites in four cases and was persistent over time in 30%. Due to lipohypertrophy, peg was discontinued in four patients, four had dose reductions and in six no action was taken. There was no correlation between the presence of escape and lipodystropy, as well as with multiple clinical variables.
Conclusions: Pegvisomant is an effective treatment for acromegaly, although 37% of responders escaped in long-term follow-up. Most patients achieved control with either dose increase, other medical treatment addition or both. Lipohypertrophy developed in 14% of patients, was persistent in 30% of cases and required drug discontinuation in 28% (four of 14).
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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