PubMed · 16211971
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P Scheinmann, M C Ducottet-Valdant, B Meyer, J P Luton, J Paupe, J Vialatte. 1977. [Acromegalogigantism].. https://pubmed.ncbi.nlm.nih.gov/16211971/
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CONTEXT/OBJECTIVE: To effectively normalize IGF-I in patients with acromegaly, various covariates may affect dosing and plasma concentrations of pegvisomant. We assessed whether sex, age, weight, and previous radiotherapy influence dosing of pegvisomant in patients with active disease. DESIGN: Data from 69 men and 49 women participating in multicenter, open-label trials of pegvisomant were retrospectively evaluated using multiple regression techniques. Sixty-nine subjects (39 men, 30 women) had undergone external beam pituitary radiotherapy. Serum IGF-I was at least 30% above age-related upper limit of normal in all patients at study entry. After a loading dose of pegvisomant (80 mg), patients were commenced on 10 mg/d. Pegvisomant dose was adjusted by 5 mg every eighth week until serum IGF-I was normalized. RESULTS: At baseline, men had significantly higher mean serum IGF-I levels than women despite similar GH levels. After treatment with pegvisomant, IGF-I levels were similar in men and women. A significant correlation between baseline GH, IGF-I, body weight, and the dose of pegvisomant required to normalize serum IGF-I was observed (all P < 0.001). Women required an average of 0.04 mg/kg more pegvisomant than men and a mean weight-corrected dose of 19.2 mg/d to normalize serum IGF-I [14.5 mg/d (men); P < 0.001]. Patients treated with radiotherapy required less pegvisomant to normalize serum IGF-I despite similar baseline GH/IGF-I levels (15.2 vs. 18.5 mg/d for no previous radiotherapy; P = 0.002). CONCLUSIONS: Sex, body weight, previous radiotherapy, and baseline GH/IGF-I influence the dose of pegvisomant required to normalize serum IGF-I in patients with active acromegaly.
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Despite ample proof to the contrary, the overwhelming number of health care practitioners still believe that acromegaly is a disease that they will rarely encounter, let alone have to treat. However, the reality is quite a bit different for both doctors and patients. Many of the obvious symptoms and signs of this disease manifest slowly and insidiously. As such, the majority of patients are often treated for seemingly unrelated conditions for years before the actual diagnosis of acromegaly is established. Thus, the overall cost of medical care for the acromegalic patient is considerably higher than appreciated at first glance. The financial cost of managing this disease must include the cost of care of comorbid conditions before and following the diagnosis of acromegaly. It is only through a higher degree of awareness that this disease will be identified earlier in its course and the true number of acromegalic patients is realized. We anticipate that such measures will serve to limit the psychological, emotional and economic burden of this potentially debilitating disease.