Long‐term experience of pegvisomant therapy as a treatment for acromegaly

Higham, Claire; Chung, Teng Teng; Lawrance, Jeremy A L; Drake, William; Trainer, Peter J

doi:10.1111/j.1365-2265.2008.03469.x

Cited by 62 publications

(36 citation statements)

References 24 publications

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“…31 Second-line and alternative treatments Patients who do not respond to SRL therapy (those in whom GH and IGF-I levels undergo minimal change) should be switched to pegvisomant treatment (SR). 33,62,63 In patients who do not respond (biochemically) to medical monotherapy, combination therapy with SRL and cabergoline or pegvisomant and cabergoline can be considered, on the basis of individual clinical considerations including tumour size and location (DR). 6,64 In patients having undergone radiation therapy, medical therapy might be required until effects are evident (SR).…”

Section: First-line Treatment Post-surgerymentioning

confidence: 99%

Expert consensus document: A consensus on the medical treatment of acromegaly

et al. 2014

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| In March 2013, the Acromegaly Consensus Group met to revise and update guidelines for the medical treatment of acromegaly. The meeting comprised experts skilled in the medical management of acromegaly. The group considered treatment goals covering biochemical, clinical and tumour volume outcomes, and the place in guidelines of somatostatin receptor ligands, growth hormone receptor antagonists and dopamine agonists, and alternative modalities for treatment including combination therapy and novel treatments. This document represents the conclusions of the workshop consensus.

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Section: First-line Treatment Post-surgerymentioning

confidence: 99%

Expert consensus document: A consensus on the medical treatment of acromegaly

et al. 2014

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“…In clinical practice upward dose titration is not always offered to cases with partial response to lower doses , and this might explain suboptimal response rates. With a more stringent dose titration protocol 95% of the cases treated for a median duration of 18 months can achieve IGF1 normalization under current clinical care (Higham et al 2009). …”

Section: Medical Treatmentmentioning

confidence: 99%

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

Căpățînă¹,

Wass²

2015

Journal of Endocrinology

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Acromegaly (ACM) is a chronic, progressive disorder caused by the persistent hypersecretion of GH, in the vast majority of cases secreted by a pituitary adenoma. The consequent increase in IGF1 (a GH-induced liver protein) is responsible for most clinical features and for the systemic complications associated with increased mortality. The clinical diagnosis, based on symptoms related to GH excess or the presence of a pituitary mass, is often delayed many years because of the slow progression of the disease. Initial testing relies on measuring the serum IGF1 concentration. The oral glucose tolerance test with concomitant GH measurement is the gold-standard diagnostic test. The therapeutic options for ACM are surgery, medical treatment, and radiotherapy (RT). The outcome of surgery is very good for microadenomas (80-90% cure rate), but at least half of the macroadenomas (most frequently encountered in ACM patients) are not cured surgically. Somatostatin analogs are mainly indicated after surgical failure. Currently their routine use as primary therapy is not recommended. Dopamine agonists are useful in a minority of cases. Pegvisomant is indicated for patients refractory to surgery and other medical treatments. RT is employed sparingly, in cases of persistent disease activity despite other treatments, due to its long-term side effects. With complex, combined treatment, at least three-quarters of the cases are controlled according to current criteria. With proper control of the disease, the specific complications are partially improved and the mortality rate is close to that of the background population.

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“…Pegvisomant, a recently introduced GH receptor antagonist, has been shown to be effective in humans with acromegaly. However, this approach is not yet an option for cats because no species-specific antagonists exist [15]. Radiation therapy may improve diabetic control in cats with acromegaly following shrinking of the pituitary tumor [1].…”

Section: Discussionmentioning

confidence: 99%