Медицинский совет (May 2020)
New opportunities for secondary drug therapy of acromegaly
Abstract
Introduction. Acromegaly is a severe multi-organ disease that negatively affects the quality and life expectancy of patients. The continuing complexity of acromegaly curation is due to the multiplicity of pathomorphological variants growth hormone-secreting adenomas and the lack of differentiated approach in choosing a therapeutic strategy. The high percentage of non-radical adenomectomy, due to the large size and invasive growth of somatotropin, involves the operative connection of adequate secondary drug therapy.Purpose. The aim of the study is to compare the effectiveness of different classes of drugs, as well as algorithms of their combined use in the treatment of acromegaly.Methods of treatment. The review uses information on factors affecting the results of clinical use of modern pharmacological preparations (somatostatin analogues, dopamine agonists, growth hormone receptor antagonists) used in secondary drug therapy of acromegaly. The indications for the administration of a drug are discussed taking into account the features of the pathomorphological structure of the tumor tissue, as well as the tactics of the therapeutic allowance in absolute or relative resistance to somatostatin analogues of the 1st generation (octreotide and lanreotide) and dopamine agonists (cabergoline). Data on efficiency of the new drug – pegvisomant providing stable control of acromegaly irrespective of secretory activity and receptor phenotype of tumor tissue are summed up.Results. Interim reports of the ACROSTUDY observational project and other clinical studies regarding the therapeutic efficacy and safety of pegvisomant are presented. A relatively low risk of continued growth of tumor tissue and other adverse reactions against the background of treatment with this drug is shown. Prognostic factors of insufficient efficiency of pegvisomant include young age, increased BMI, high initial level of ИРФ-1, presence of diabetes mellitus. There is an advantage of combined use of pegvisomant and somatostatin analogues to maintain acromegaly control and prevent tumor growth. The topic of primary therapy of pegvisomant is touched upon. Based on the results of real clinical practice, modern international recommendations are presented, which indicate the place of pegvisomant in the algorithm of secondary drug therapy.Conclusions. Due to the introduction into clinical practice of various therapeutic agents, which allow, regardless of the activity of the disease, the specificity of the pathomorphological structure of tumor tissue and somatic status, to achieve stable maintenance of biochemical remission, patients have real opportunities for improving the quality and life expectancy.
Keywords
