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J Clin Endocrinol Metab. 2005 Oct;90(10):5684-91. Epub 2005 Aug 2.

Glucose homeostasis and safety in patients with acromegaly converted from long-acting octreotide to pegvisomant.

Author information

1
Department of Internal Medicine, University of Michigan Medical Center, 3920 Taubman Center, Ann Arbor, Michigan 48109-0354, USA. abarkan@med.umich.edu

Abstract

CONTEXT:

In clinical practice, patients with acromegaly may be switched from therapy with long-acting somatostatin analogs to pegvisomant. The effect of changing therapies on glucose homeostasis and safety has not been reported.

OBJECTIVES:

The objectives of this study were to monitor changes in IGF-I levels, glycemic control, and safety, particularly liver function and tumor size.

DESIGN:

This was a multicenter, open-label, 32-wk trial study.

SETTING:

The study was performed at outpatient clinics.

PATIENTS:

Fifty-three patients with acromegaly previously treated with octreotide long-acting release (LAR) participated in this study.

INTERVENTION:

Pegvisomant (10 mg/d) was initiated 4 wk after the last dose of octreotide LAR and was adjusted based on serum IGF-I concentrations at wk 12, 20, and 28.

MAIN OUTCOME MEASURES:

The main outcome measures were changes in IGF-I, glycosylated hemoglobin A1c (HbA1c), fasting plasma glucose, and safety during the first 12 wk after conversion.

RESULTS:

At the end of pegvisomant treatment, IGF-I was normalized in 78% of patients. At wk 32, median fasting glucose concentration and HbA1c were reduced (-1.4 mmol/liter and -0.4%, respectively; both P < or = 0.0001) in the study population. Improvements in glycemic control occurred in patients with normal IGF-I concentrations at wk 4 [n = 15; fasting glucose, -1.7 mmol/liter (P < or = 0.0001); HbA1c -0.2% (P = 0.03)]. Decreases in fasting glucose and HbA1c levels were observed in patients with and without diabetes. HbA1c was reduced by more than 1.0% in patients with diabetes. Median pituitary tumor volume did not change, although tumor volume increased in two patients with macroadenomas.

CONCLUSIONS:

Conversion from octreotide LAR to pegvisomant was safe and well tolerated. Improved glycemic control indicates that pegvisomant should be considered in patients with acromegaly and diabetes.

PMID:
16076947
DOI:
10.1210/jc.2005-0331
[Indexed for MEDLINE]

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