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Pegvisomant and cabergoline combination therapy in acromegaly

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Abstract

Combination with cabergoline may offer additional benefits to acromegalic patients on pegvisomant monotherapy. We evaluated the safety and efficacy profile of this combination and investigated the determinants of response. An observational, retrospective, cross-sectional study. Fourteen acromegalic patients (9 females), who were partially resistant to somatostatin analogs and on pegvisomant monotherapy. Cabergoline was added because of the presence of persistent mildly increased IGF-I. The mean follow-up time was 18.3 ± 10.4 months. The efficacy and safety profile was assessed. The influence of clinical and biochemical characteristics on treatment efficacy was studied. IGF-I levels returned to normal in 4 patients (28%) at the end of the study. In addition, some decline in IGF-I levels was observed in a further 5 patients. The % IGF-I decreased from 158 ± 64% to 124 ± 44% (p = 0.001). The average change in IGF-I was −18 ± 27% (range −67 to +24%). Lower baseline IGF-I (p = 0.007), female gender (p = 0.013), lower body weight (p = 0.031), and higher prolactin (PRL) levels (p = 0.007) were associated with a better response to combination therapy. There were no significant severe adverse events. Significant tumour shrinkage was observed in 1 patient. Combination therapy with pegvisomant and cabergoline could provide better control of IGF-I in some patients with acromegaly. Baseline IGF-I levels, female gender, body weight, and PRL levels affect the response to this combination therapy.

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Acknowledgments

We are grateful to Angel Salgado Barreira, biomedical research technician, for his invaluable assistance with the statistical analysis. This work was supported by Grants FISS 07/1119 (to M.M.) and 11/00161 (to IB).

Conflict of interest

I.B., T.L. and M.M. hold research grants from Pfizer and have received lecture fees from Novartis, Ipsen, and Pfizer. F.F.C. holds research grants from Pfizer and Novartis has and received lecture fees from Pfizer and Novartis. The remaining authors do not have any conflicts of interest that could be perceived as prejudicing the impartiality of the research reported.

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Authors and Affiliations

  1. Endocrinology Department, Complejo Hospitalario Universitario de Santiago de Compostela (SERGAS), Travesía de la Choupana s/n, 15706, Santiago de Compostela, Spain

    I. Bernabeu, J. M. Cabezas-Agrícola & F. F. Casanueva

  2. Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Universidad de Santiago de Compostela, Santiago de Compostela, Spain

    I. Bernabeu, J. M. Cabezas-Agrícola & F. F. Casanueva

  3. Endocrinology Department, Hospital Universitario La Paz, Madrid, Spain

    C. Alvarez-Escolá

  4. Universidad Autónoma de Madrid, Madrid, Spain

    C. Alvarez-Escolá, T. Lucas & M. Marazuela

  5. Endocrinology Department, Hospital Infanta Cristina Parla, Madrid, Spain

    A. E. Paniagua

  6. Endocrinology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain

    T. Lucas

  7. Endocrinology Department, Hospital Universitario de Getafe, Getafe, Madrid, Spain

    I. Pavón

  8. Universidad Europea de Madrid, Madrid, Spain

    I. Pavón

  9. Endocrinology Department, Hospital Universitario La Princesa, Instituto de Investigación la Princesa (IP), Madrid, Spain

    M. Marazuela

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  1. I. Bernabeu
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  2. C. Alvarez-Escolá
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  3. A. E. Paniagua
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  7. F. F. Casanueva
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  8. M. Marazuela
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Correspondence to I. Bernabeu.

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Bernabeu, I., Alvarez-Escolá, C., Paniagua, A.E. et al. Pegvisomant and cabergoline combination therapy in acromegaly. Pituitary 16, 101–108 (2013). https://doi.org/10.1007/s11102-012-0382-z

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  • DOI: https://doi.org/10.1007/s11102-012-0382-z

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