Manuel Puig-Domingo1, Alfonso Soto2, Eva Venegas2, Ricardo Vilchez3, Concepción Blanco4, Fernando Cordido5, Tomás Lucas6, Mónica Marazuela7, Rosa Casany8, Guillem Cuatrecasas9, Carmen Fajardo10, María Ángeles Gálvez11, Silvia Maraver12, Tomás Martín13, Enrique Romero14, Miguel Paja15, Antonio Picó16, Ignacio Bernabeu17, Eugenia Resmini18. 1. Hospital Universitario Germans Trias i Pujol, Carretera Canyet, s/n 08916 Badalona, Barcelona, Spain. Electronic address: mpuigd@igtp.cat. 2. Hospital Universitario Virgen del Rocío, Av Manuel Siurot, 0, 41013 Sevilla, Spain. 3. Hospital Universitario Virgen de las Nieves, Av de las Fuerzas Armadas, 2, 18014 Granada, Spain. 4. Hospital Universitario Príncipe de Asturias, Carretera Alcalá-Meco, s/n, 28805 Alcalá de Henares, Madrid, Spain. 5. Hospital Universitario A Coruña, As Xubias, 84, 15006 A Coruña, Spain. 6. Hospital Universitario Puerta de Hierro, Calle Manuel de Falla, 1, 28222 Majadahonda, Madrid, Spain. 7. Hospital Universitario La Princesa, Calle de Diego León, 62, 28006 Madrid, Spain. 8. Hospital Lluis Alcanyís, Carretera Xàtiva-Silla, km 2, 46800 Xàtiva, Spain. 9. Centro Médico Teknon, Carrer de Vilana, 12, 08022 Barcelona, Spain. 10. Hospital Universitario La Ribera, Carretera Corbera, km 1, 46600 Alzira, Valencia, Spain. 11. Hospital Universitario Reina Sofía, Avda. Menéndez Pidal, s/n, 14004 Córdoba, Spain. 12. Hospital Clínico Universitario Virgen de la Victoria, Campus Universitario de Teatinos, s/n, 29010, Málaga, Spain. 13. Hospital Universitario Virgen Macarena, Avd. Dr. Fedriani, 3, 41007 Sevilla, Spain. 14. Hospital Clínico Universitario, Av Ramón y Cajal, 3, 47005 Valladolid, Spain. 15. Hospital Universitario de Basurto, Avda. de Montevideo N° 18, (Carretera N-634), 48013 Bilbao, Spain. 16. Hospital General Universitario de Alicante, Av Pintor Baeza, 12, 03010 Alicante, Spain. 17. Hospital Clínico Universitario, Travesía de Choupana, s/n, 15706 Santiago de Compostela, Spain. 18. Endocrinología, Hospital Sant Pau, Pare Claret, 167, Barcelona, Spain.
Abstract
PURPOSE: To describe real-world use of lanreotide combination therapy for acromegaly. PATIENTS AND METHODS: ACROCOMB is a retrospective observational Spanish study of patients with active acromegaly treated with lanreotide combination therapy between 2006 and 2011. 108 patients treated at 44 Spanish Endocrinology Departments were analyzed separately: 61 patients received lanreotide/cabergoline (cabergoline cohort) and 47 lanreotide/pegvisomant (pegvisomant cohort). RESULTS: Patient median age was 50.8 years in the cabergoline cohort and 42.7 years in the pegvisomant cohort. Prior medical treatments were somatostatin analogue (SSA) monotherapy (40 [66%] patients) or dopamine agonists (7 [11%] patients) in the cabergoline cohort and SSA (29 [62%] patients) or pegvisomant monotherapy (16 [34%] patients) in the pegvisomant cohort. Across both cohorts 12 patients were previously untreated, and prior therapy was unknown/missing in 4 patients. Median duration of combined treatment was 1.6 years (0.1-6) and 2.1 years (0.4-6.3) in the cabergoline and pegvisomant cohorts, respectively. At baseline, median insulin growth factor (IGF)-I values were 149% upper limit of normal (ULN) (15-505%) in the cabergoline cohort and 156% ULN (15-534%) in the pegvisomant cohort, and decreased to 104% ULN (13-557%) p<0.001 and 86% ULN (23-345%) p<0.0001, respectively, at end of study (EOS). Normal age-adjusted values of IGF-I were obtained in 48% of lanreotide/cabergoline-treated patients and 70% of lanreotide/pegvisomant-treated patients at EOS. There were no significant changes in hepatic, cardiac or glycaemic parameters in either cohort. CONCLUSION: In clinical practice lanreotide treatment combinations are useful options for patients with acromegaly when monotherapy is insufficient; particularly, the combination of lanreotide and pegvisomant in patients not controlled with either SSA or pegvisomant alone has high efficacy and is well-tolerated.
PURPOSE: To describe real-world use of lanreotide combination therapy for acromegaly. PATIENTS AND METHODS: ACROCOMB is a retrospective observational Spanish study of patients with active acromegaly treated with lanreotide combination therapy between 2006 and 2011. 108 patients treated at 44 Spanish Endocrinology Departments were analyzed separately: 61 patients received lanreotide/cabergoline (cabergoline cohort) and 47 lanreotide/pegvisomant (pegvisomant cohort). RESULTS:Patient median age was 50.8 years in the cabergoline cohort and 42.7 years in the pegvisomant cohort. Prior medical treatments were somatostatin analogue (SSA) monotherapy (40 [66%] patients) or dopamine agonists (7 [11%] patients) in the cabergoline cohort and SSA (29 [62%] patients) or pegvisomant monotherapy (16 [34%] patients) in the pegvisomant cohort. Across both cohorts 12 patients were previously untreated, and prior therapy was unknown/missing in 4 patients. Median duration of combined treatment was 1.6 years (0.1-6) and 2.1 years (0.4-6.3) in the cabergoline and pegvisomant cohorts, respectively. At baseline, median insulin growth factor (IGF)-I values were 149% upper limit of normal (ULN) (15-505%) in the cabergoline cohort and 156% ULN (15-534%) in the pegvisomant cohort, and decreased to 104% ULN (13-557%) p<0.001 and 86% ULN (23-345%) p<0.0001, respectively, at end of study (EOS). Normal age-adjusted values of IGF-I were obtained in 48% of lanreotide/cabergoline-treated patients and 70% of lanreotide/pegvisomant-treated patients at EOS. There were no significant changes in hepatic, cardiac or glycaemic parameters in either cohort. CONCLUSION: In clinical practice lanreotide treatment combinations are useful options for patients with acromegaly when monotherapy is insufficient; particularly, the combination of lanreotide and pegvisomant in patients not controlled with either SSA or pegvisomant alone has high efficacy and is well-tolerated.
Authors: Michiel J van Esdonk; Eline J M van Zutphen; Ferdinand Roelfsema; Alberto M Pereira; Piet H van der Graaf; Nienke R Biermasz; Jasper Stevens; Jacobus Burggraaf Journal: Pituitary Date: 2018-06 Impact factor: 4.107