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Medical treatment in acromegaly: a network meta-analysis
Chrysi Kaparounaki1, Mirela-Diana Ilie2,3, Dario De Alcubierre4
1Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.
European Journal of Endocrinology
|October 27, 2025
Summary
Pegvisomant and pasireotide LAR are most effective for normalizing insulin-like growth factor 1 (IGF-1) in acromegaly. Pasireotide LAR also showed the best tumor shrinkage, though more research is needed.
Area of Science:
- Endocrinology
- Oncology
- Pharmacology
Background:
- Acromegaly is a rare disorder caused by growth hormone-secreting pituitary adenomas.
- Limited clinical trial evidence exists for acromegaly management.
- Medical treatments aim to normalize IGF-1 levels and reduce tumor size.
Purpose of the Study:
- To compare the efficacy of various medical treatments for acromegaly.
- To assess biochemical (IGF-1 normalization) and radiological (tumor shrinkage) responses.
- To provide evidence for optimizing acromegaly management.
Main Methods:
- Systematic review and network meta-analysis.
- Searched PubMed, Scopus, and Web of Science up to June 2024.
- Included randomized controlled trials and nonrandomized studies.
Main Results:
- Pegvisomant and pasireotide LAR were most effective for IGF-1 normalization.
- Pasireotide LAR demonstrated superior tumor shrinkage compared to somatostatin receptor ligands (SRLs).
- Pegvisomant and pasireotide LAR outperformed SRLs combined with dopamine agonists for IGF-1 normalization.
Conclusions:
- Pasireotide LAR and pegvisomant are promising treatments for IGF-1 normalization in acromegaly.
- Pasireotide LAR shows potential for tumor shrinkage, but evidence is limited.
- Further research is needed to evaluate their role as first-line therapies post-surgery, considering cost and safety.
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