Efficacy and tolerability of treatment with pegvisomant in acromegaly: an overview of literature

Introduction: Acromegaly is characterized by increased release of growth hormone (GH) and IGF-I generally induced by a pituitary adenoma. Therapies for acromegaly aim at controlling tumor growth and normalizing hormonal excess, and include surgery, pharmacotherapy, and radiotherapy.Area covered: This review focuses on efficacy and tolerability of the GH receptor antagonist pegvisomant (PEG), widely used in acromegaly as second- or third-line treatment, mainly after unsuccessful surgery and/or radiotherapy, or in patients with a proven resistance to conventional somatostatin analogs (SSA). The response to PEG takes into account control of IGF-I excess and improvement of clinical symptoms directly related to IGF-I hypersecretion, whereas PEG does not exert a direct action on GH oversecretion and tumor mass. The response to PEG treatment depends on proper dose adjustment and patient compliance, as it is approved as daily subcutaneous injection. However, PEG can be added to SSA in patients non- or partly resp...