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Terapia combinada con análogos de somatostatina y pegvisomant semanal en la acromegalia activa
J Feenstra1, W W de Herder, S M T H ten Have
1Department of Internal Medicine, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands.
Lancet (London, England)
|May 12, 2005
Resumen
La combinación de análogos de somatostatina de acción prolongada mensuales con pegvisomant semanal normaliza efectivamente los niveles de factor de crecimiento similar a la insulina I (IGF-I) en pacientes con acromegalia. Este enfoque ofrece una opción de tratamiento potencialmente rentable.
Área de la Ciencia:
- Endocrinología Endocrinología.
- Farmacología Farmacología.
Sus antecedentes:
- La acromegalia se caracteriza por una producción excesiva de la hormona del crecimiento, lo que lleva a niveles elevados de factor de crecimiento similar a la insulina I (IGF-I).
- La monoterapia con pegvisomant normaliza el IGF-I, pero está asociada con altos costos.
- Las estrategias de tratamiento actuales tienen como objetivo normalizar el IGF-I y controlar las complicaciones de la enfermedad.
Objetivo del estudio:
- Para evaluar la eficacia de una terapia de combinación para la acromegalia.
- Para evaluar la combinación de análogos mensuales de somatostatina de acción prolongada y pegvisomant semanal.
- Para determinar un régimen de dosificación óptimo para pegvisomant en la terapia de combinación.
Principales métodos:
- Un estudio de detección de dosis de 42 semanas en el que participaron 26 pacientes con acromegalia activa.
- Los pacientes recibieron análogos de somatostatina de acción prolongada mensualmente y pegvisomant semanalmente.
- La dosis de pegvisomant se incrementó semanalmente hasta que se alcanzó la normalización de IGF-I o un máximo de 80 mg/semana.
Principales resultados:
- El 95% de los pacientes (18/19) que completaron 42 semanas lograron concentraciones normales de IGF-I.
- La mediana de la dosis semanal efectiva de pegvisomant fue de 60 mg (rango de 40-80 mg).
- No se observó crecimiento de tumor pituitario; elevaciones leves de enzimas hepáticas ocurrieron en el 38% de los pacientes.
Conclusiones:
- La terapia combinada con análogos mensuales de somatostatina y pegvisomant semanal es efectiva para el tratamiento de la acromegalia.
- Este régimen puede mejorar el cumplimiento del paciente y reducir significativamente los costos del tratamiento.
- Se necesitan más investigaciones para confirmar la seguridad a largo plazo y la rentabilidad.
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