Use of lanreotide in combination with cabergoline or pegvisomant in patients with acromegaly in the clinical practiceThe ACROCOMB study
- Manuel Puig Domingo 17
- Alfonso Manuel Soto Moreno 1
- Eva Venegas Moreno 1
- Ricardo Vílchez Joya 2
- Concepción Blanco Carrera 3
- Fernando Cordido Carballido 4
- Tomás Lucas Morante 5
- Mónica Marazuela Azpiroz 6
- Rosa María Casañ Fernández 7
- Guillem Cuatrecasas Cambra 8
- Carmen Fajardo Montañana 9
- María Angeles Gálvez Moreno 10
- Silvia Maraver Selfa 11
- Tomás Martín Hernández 18
- Enrique Romero Bobillo 12
- Miguel Paja Fano 13
- Antonio Miguel Picó Alfonso 14
- Ignacio Bernabeu Morón 15
- Eugenia Resmini 16
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Hospital Universitario Virgen del Rocío
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Hospital Universitario Virgen de las Nieves
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Hospital Universitario Príncipe de Asturias
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- 4 Hospital Universitario de A Coruña
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Hospital Universitario Puerta de Hierro
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Hospital Universitario de la Princesa
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Hospital Xàtiva Lluis Alcanyis
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Centro Medico Teknon
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- 9 Hospital Universitario de La Ribera
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Hospital Universitario Reina Sofia
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Hospital Universitario Virgen de la Victoria
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Hospital Universitario de Valladolid
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Hospital Universitario de Basurto
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- 14 Hospital General Universitari d´Alacant
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Complexo Hospitalario Universitario de Santiago
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Complexo Hospitalario Universitario de Santiago
Santiago de Compostela, España
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Hospital de la Santa Creu i Sant Pau
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- 17 Hospital Germans Trias i Pujol
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Hospital Universitario Virgen Macarena
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ISSN: 1575-0922
Year of publication: 2016
Volume: 63
Issue: 8
Pages: 397-408
Type: Article
More publications in: Endocrinología y nutrición: órgano de la Sociedad Española de Endocrinología y Nutrición
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.
Funding information
No conflict of interest: RV, CB, RC, CF, SM, TM, TL, MM. Conflicts of interest include: • Employment and consultancies: MP-D: consultancies from Pfizer. • Grants, fees and honoraria: MP-D has received lecture honoraria from Novartis, Pfizer and Ipsen; FC: has received lecture honoraria from Novartis and Pfizer and unrestricted research grants from Ipsen Pharma; MP: speaker fees from Ipsen and Pfizer; AS: Clinical trials and donations for investigator-initiated research projects by Ipsen, Novartis and Pfizer; AP: advisory board Pfizer; IB: Advisory fees: Pfizer; research grants: Pfizer; lectures fees: Pfizer, Novartis. • Board membership: MP-D: Pfizer.Funders
- Novartis Switzerland
- Ipsen Biopharmaceuticals United States
- Pfizer United States