Pegvisomant in combination or pegvisomant alone after failure of somatostatin analogs in acromegaly patients: an observational French ACROSTUDY cohort study - Université de Picardie Jules Verne Accéder directement au contenu
Article Dans Une Revue Endocrine Année : 2020

Pegvisomant in combination or pegvisomant alone after failure of somatostatin analogs in acromegaly patients: an observational French ACROSTUDY cohort study

Philippe Caron
Yves Brault
  • Fonction : Auteur

Résumé

Objective: After surgery, when somatostatin analogs (SAs) do not normalize IGF-I, pegvisomant (PEG) is indicated. Our aim was to define the medical reasons for the treatment of patients with PEG as monotherapy (M) or combined with SA, either as primary bitherapy, PB (PEG is secondarily introduced after SA) or as secondary bitherapy, SB (SAs secondarily introduced after PEG). Methods: We retrospectively analyzed French data from ACROSTUDY. Results 167, 88, and 57 patients were treated with M, PB, or SB, respectively, during a median time of 80, 42, and 70 months. The median PEG dose was respectively 15, 10, and 20 mg. Before PEG, the mean IGF-I level did not differ between M and PB, but the proportion of patients with suprasellar tumor extension was higher in the PB group (67.5% vs. 44.4%, P = 0.022). SB regimen was used preferentially in patients with tumor increase and IGF-I level difficult to normalize under PEG. In both secondary regimens, the decrease in the frequency of PEG's injections, compared to monotherapy, was confirmed. However, the mean weekly dose of PEG between M and PB remained the same. Conclusions: The medical rationale for continuing SAs rather than switching to PEG alone in patients who do not normalize IGF-I under SAs was a tumor concern with suprasellar extension and tumor shrinkage under SA. A potential explanation for introducing SA in association with PEG appears to be tumor enlargement and difficulties to normalize IGF-I levels under PEG given alone. In both regimens, the prospect of lowering PEG injection frequency favored the choice.
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hal-03555793 , version 1 (24-12-2023)

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Emmanuelle Kuhn, Philippe Caron, Brigitte Delemer, Isabelle Raingeard, Herve Lefebvre, et al.. Pegvisomant in combination or pegvisomant alone after failure of somatostatin analogs in acromegaly patients: an observational French ACROSTUDY cohort study. Endocrine, 2020, 71 (1), pp.158-167. ⟨10.1007/s12020-020-02501-3⟩. ⟨hal-03555793⟩
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