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Preconception use of pegvisomant alone or as combination therapy for acromegaly: a case series and review of the literature

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Abstract

Purpose

Pegvisomant (PEG) is an effective therapy for acromegaly. Its safety in women seeking fertility and during pregnancy has been scarcely reported.

Methods

A retrospective chart review was performed in three patients with acromegaly who received PEG while attempting to conceive. Published studies regarding this topic were analyzed.

Results

Four pregnancies in three women with acromegaly are reported. In the first patient, PEG was withdrawn three days before embryo transfer in her first pregnancy and 2 weeks prior to transfer in the second pregnancy. Each transfer resulted in a healthy full-term newborn. In the second and third patients, PEG was withdrawn at diagnosis of pregnancy. No fetal complications occurred during gestations which resulted in three full-term newborns (one single and one twin pregnancy). No abnormalities in development were found in the five live births described. Few cases of pregnancies in women exposed to PEG have been reported and therefore safety cannot be clearly established. In this series, all four pregnancies had good outcomes with discontinuation of the drug before or at first knowledge of conception. A review of the literature reveals no evident drug-related abnormalities in the offspring, even in the few women with continued use of PEG throughout pregnancy.

Conclusion

Preconception therapy with PEG resulted in successful fertility outcomes. Although few cases have been reported, these four pregnancies with PEG use prior to or at the time of conception were not associated with significant maternal or fetal complications. More studies are needed to establish the safety of PEG preconception.

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All data is available in the text.all data is available in the text.

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Funding

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Author information

Author notes

  1. F. J. Guarda and W. Gong have contributed equally to this work.

Authors and Affiliations

  1. Neuroendocrine and Pituitary Tumor Clinical Center, Massachusetts General Hospital, Harvard Medical School, 100 Blossom street, Cox building, Suite 140, Boston, MA, 02114, USA

    F. J. Guarda, A. Ghajar & L. B. Nachtigall

  2. Department of Endocrinology and Center for Translational Endocrinology (CETREN), School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile

    F. J. Guarda

  3. Department of Endocrinology, Huashan Hospital, Fudan University, Shanghai, China

    W. Gong

  4. Endocrinology Division, Hospital Carlos G. Durand, Buenos Aires, Argentina

    M. Guitelman

Authors
  1. F. J. Guarda
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  2. W. Gong
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  4. M. Guitelman
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  5. L. B. Nachtigall
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Contributions

LBN conceived of and directed the study and provided clinical information on case 1. MG provided clinical information on cases 2 and 3. WG and FJG extracted the clinical data, performed the literature search and drafted the manuscript. WG, FJG, AG, MG and LBN collectively revised the manuscript and approved its final form.

Corresponding author

Correspondence to L. B. Nachtigall.

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Conflict of interest

WG, FJG and AG: none. MG received honoraria for consulting from Pfizer and Sanofi-Aventis and from Novartis for an ongoing trial. LBN received honoraria for consulting from Pfizer and Ipsen, and research funds from Ipsen and Chiasma.

Ethical approval

The study was approved by the Institutional Review Board of Partners Healthcare.

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Not applicable for retrospective observational study.

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Not applicable for retrospective observational study.

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Guarda, F.J., Gong, W., Ghajar, A. et al. Preconception use of pegvisomant alone or as combination therapy for acromegaly: a case series and review of the literature. Pituitary 23, 498–506 (2020). https://doi.org/10.1007/s11102-020-01050-2

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  • DOI: https://doi.org/10.1007/s11102-020-01050-2

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