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

2.50
Hdl Handle:
http://hdl.handle.net/10541/76603
Title:
Glucose homeostasis and safety in patients with acromegaly converted from long-acting octreotide to pegvisomant.
Authors:
Barkan, Ariel L; Burman, Pia; Clemmons, David R; Drake, William M; Gagel, Robert F; Harris, Philip E; Trainer, Peter J; Van der Lely, A J; Vance, Mary Lee
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.
Affiliation:
Department of Internal Medicine, University of Michigan Medical Center, 3920 Taubman Center, Ann Arbor, Michigan 48109-0354, USA. abarkan@med.umich.edu
Citation:
Glucose homeostasis and safety in patients with acromegaly converted from long-acting octreotide to pegvisomant. 2005, 90 (10):5684-91 J. Clin. Endocrinol. Metab.
Journal:
The Journal of Clinical Endocrinology and Metabolism
Issue Date:
Oct-2005
URI:
http://hdl.handle.net/10541/76603
DOI:
10.1210/jc.2005-0331
PubMed ID:
16076947
Type:
Article
Language:
en
ISSN:
0021-972X
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorBarkan, Ariel L-
dc.contributor.authorBurman, Pia-
dc.contributor.authorClemmons, David R-
dc.contributor.authorDrake, William M-
dc.contributor.authorGagel, Robert F-
dc.contributor.authorHarris, Philip E-
dc.contributor.authorTrainer, Peter J-
dc.contributor.authorVan der Lely, A J-
dc.contributor.authorVance, Mary Lee-
dc.date.accessioned2009-08-06T15:48:54Z-
dc.date.available2009-08-06T15:48:54Z-
dc.date.issued2005-10-
dc.identifier.citationGlucose homeostasis and safety in patients with acromegaly converted from long-acting octreotide to pegvisomant. 2005, 90 (10):5684-91 J. Clin. Endocrinol. Metab.en
dc.identifier.issn0021-972X-
dc.identifier.pmid16076947-
dc.identifier.doi10.1210/jc.2005-0331-
dc.identifier.urihttp://hdl.handle.net/10541/76603-
dc.description.abstractCONTEXT: 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.en
dc.language.isoenen
dc.subjectPituitary Canceren
dc.subject.meshAcromegaly-
dc.subject.meshAdenoma-
dc.subject.meshAdolescent-
dc.subject.meshAdult-
dc.subject.meshArea Under Curve-
dc.subject.meshBlood Glucose-
dc.subject.meshDelayed-Action Preparations-
dc.subject.meshFemale-
dc.subject.meshGlucose-
dc.subject.meshGlucose Tolerance Test-
dc.subject.meshHemoglobin A, Glycosylated-
dc.subject.meshHomeostasis-
dc.subject.meshHuman Growth Hormone-
dc.subject.meshHumans-
dc.subject.meshInsulin-
dc.subject.meshInsulin-Like Growth Factor I-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshOctreotide-
dc.subject.meshPituitary Neoplasms-
dc.titleGlucose homeostasis and safety in patients with acromegaly converted from long-acting octreotide to pegvisomant.en
dc.typeArticleen
dc.contributor.departmentDepartment of Internal Medicine, University of Michigan Medical Center, 3920 Taubman Center, Ann Arbor, Michigan 48109-0354, USA. abarkan@med.umich.eduen
dc.identifier.journalThe Journal of Clinical Endocrinology and Metabolismen

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