Experience of using pegvisomantin the combined treatment of acromegaly


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Abstract

Background. Acromegaly is a serious multi-organ disease, the life prognosis of which depends on timely diagnosis and adequacy of medical condition. The article presents preliminary results of the use of pegvisomant in the complex treatment of acromegaly, as well as data on the combined regimens of medical therapy, increasing the effectiveness of treatment and implementing a personalized approach to the treatment of acromegaly. Methods. The prospective study included 15 patients with acromegaly (4 men and 11 women) with the continued activity of the disease, despite the surgical treatment and long-term intake of analogues of somatostatin 1st generation (AS1). A laboratory-instrumental examination (determination oflevels of GH, IGF-1, hepatic enzymes, blood sugar, MRI of the brain) was previously performed on all patients. To achieve control in addition to AS1, a pegvisomant was added at a dose of 10 mg daily, which patients received for 1-4 months. The work analyzes the first results regarding the efficiency and safety of the pegvisomant. A comparative analysis of clinical studies regarding the effectiveness and tolerability of combined drug therapy regimens has been carried out. Results. The presented group of patients initially differed in early age of diagnosis, large size of the tumors with high secretory activity and low sensitivity to AS1. A positive effect was achieved in 8 out of 15 patients while taking pegvisomant (53%): 5 patients had biochemical remission and 3 patients showed a decrease in the index of IGF-1 by 27-49% of the original level. The possibilities of various combination treatment regimens in the presence of resistance to AS1 depending on the receptor phenotype and the severity of metabolic disorders are discussed. Conclusion. Preliminary results indicate that the use of pegvisomant in combination with analogues of somatostatin 1st generation allows for improved drug benefit efficacy and patient adherence to treatment.

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About the authors

E. V Pronin

Endocrinological Dispensary of Moscow Health Care Department

Moscow, Russia

M. B Antsiferov

Endocrinological Dispensary of Moscow Health Care Department

Moscow, Russia

T. M Alekseeva

Endocrinological Dispensary of Moscow Health Care Department

Moscow, Russia

Vyacheslav S. Pronin

Russian Medical Academy of Continuing Professional Education

Email: vspronin@yandex.ru
Dr. Sci. (Med.) 7, 2nd Botkinsky pr-d, Moscow 125284, Russian Federation

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