A retrospective multicenter study of pegvisomant use in acromegaly within Russian Federation

BACKGROUND : Acromegaly is a chronic neuroendocrine disorder, the prognosis of which depends on timely and adequate treatment. A high percentage of non-radical surgical treatment and the problem of resistance to first-line drug therapy necessitate the timely inclusion of second-line drugs. AIM : To evaluate the efficacy and safety of pegvisomant (PEG) therapy in patients with unsatisfactory acromegaly control. MATERIALS AND METHODS : The characteristics and treatment outcomes of 185 patients with acromegaly who did not achieve biochemical remission with somatostatin analogs were analyzed. These patients received PEG therapy at three medical centers in Moscow, Russia, between 2019 and 2024. During treatment, dynamic monitoring of insulin-like growth factor 1 (IGF-1) levels, carbohydrate metabolism indicators, liver transaminases, and contrast-enhanced magnetic resonance imaging (MRI) of the brain were performed. RESULTS: PEG treatment resulted in sustained biochemical remission of acromegaly in 70.8% of patients. The average daily PEG dose was 15 mg. A direct relationship was established between the drug dose and the initial IGF-1 level, body mass index (BMI), and glycated hemoglobin level. The use of the drug was not associated with significant changes in pituitary adenoma size or the development of serious adverse events. CONCLUSION: Timely inclusion of a second-line drug (PEG) in the treatment regimen of patients who did not achieve control with high-dose monotherapy with somatostatin analogs allows for achieving sustained biochemical control of acromegaly with minimal side effects.