Use of lanreotide in combination with cabergoline or pegvisomant in patients with acromegaly in the clinical practice: The ACROCOMB study

作者：Puig Domingo Manuel^*; Soto Alfonso; Venegas Eva; Vilchez Ricardo; Blanco Concepcion; Cordido Fernando; Lucas Tomas; Marazuela Monica; Casany Rosa; Cuatrecasas Guillem; Fajardo Carmen; Galvez Maria Angeles; Maraver Silvia; Martin Tomas; Romero Enrique; Paja Miguel; Pico Antonio; Bernabeu Ignacio; Resmini Eugenia

来源：Endocrinologia y Nutricion, 2016, 63(8): 397-408.

DOI：10.1016/j.endonu.2016.05.010

• Acromegaly
• Lanreotide
• Cabergoline
• Pegvisomant
• IGF-I
• Somatostatin analogues

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.

• 出版日期2016-10