Use of lanreotide in combination with cabergoline or pegvisomant in patients with acromegaly in the clinical practice: The ACROCOMB study
Endocrinol Nutr. 2016 Oct;63(8):397-408.
doi: 10.1016/j.endonu.2016.05.010.
Epub 2016 Jul 20.
[Article in
English,
Spanish]
Authors
Manuel Puig-Domingo
1
, Alfonso Soto
2
, Eva Venegas
2
, Ricardo Vilchez
3
, Concepción Blanco
4
, Fernando Cordido
5
, Tomás Lucas
6
, Mónica Marazuela
7
, Rosa Casany
8
, Guillem Cuatrecasas
9
, Carmen Fajardo
10
, María Ángeles Gálvez
11
, Silvia Maraver
12
, Tomás Martín
13
, Enrique Romero
14
, Miguel Paja
15
, Antonio Picó
16
, Ignacio Bernabeu
17
, Eugenia Resmini
18
; ACROCOMB study group
Affiliations
- 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.
Keywords:
Acromegalia; Acromegaly; Análogos de la somatostatina; Cabergolina; Cabergoline; IGF-I; Lanreotida; Lanreotide; Pegvisomant; Somatostatin analogues.
Copyright © 2016 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.
MeSH terms
-
Acromegaly / drug therapy*
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Cabergoline
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Dopamine Agonists / administration & dosage
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Dopamine Agonists / therapeutic use*
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Drug Therapy, Combination / adverse effects*
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Ergolines / administration & dosage
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Ergolines / chemistry
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Ergolines / pharmacology*
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Human Growth Hormone / administration & dosage
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Human Growth Hormone / analogs & derivatives*
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Human Growth Hormone / pharmacology
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Human Growth Hormone / therapeutic use
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Humans
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Insulin-Like Growth Factor I / analysis
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Insulin-Like Growth Factor I / chemistry
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Insulin-Like Growth Factor I / metabolism*
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Peptides, Cyclic / administration & dosage
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Peptides, Cyclic / chemistry
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Peptides, Cyclic / pharmacology*
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Retrospective Studies
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Somatostatin / administration & dosage
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Somatostatin / analogs & derivatives*
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Somatostatin / chemistry
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Somatostatin / pharmacology
Substances
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Dopamine Agonists
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Ergolines
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Peptides, Cyclic
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lanreotide
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Human Growth Hormone
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Somatostatin
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Insulin-Like Growth Factor I
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Cabergoline
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pegvisomant