JOURNAL ARTICLE

Cost-effectiveness and efficacy of a novel combination regimen in acromegaly: a prospective, randomized trial

Vivien Bonert, James Mirocha, John Carmichael, Kevin C J Yuen, Takako Araki, Shlomo Melmed
Journal of Clinical Endocrinology and Metabolism 2020 July 10
32754748

CONTEXT: Combination therapy with somatostatin receptor ligand (SRL) plus pegvisomant for acromegaly patients is recommended after maximizing dose on monotherapy. Lower-dose combination regimens are not well-studied.

OBJECTIVE: To compare cost-effectiveness and efficacy of three lower-dose combination regimens in controlled and uncontrolled acromegaly.

DESIGN AND SETTING: Prospective, randomized, open-label, parallel arm study at a tertiary referral pituitary center.

PATIENTS: Adults with acromegaly regardless of response to prior SRL and biochemical control status at baseline, stratified by SRL dose required for IGF-I normalization during any 3-month period within 12 months preceding enrollment.

INTERVENTION: Combination therapy for 24-32 weeks on Arm A, high-dose SRL (lanreotide 120 mg/octreotide LAR 30 mg) plus weekly pegvisomant (40-160 mg/week); Arm B, low-dose SRL (lanreotide 60 mg/octreotide LAR 10 mg) plus weekly pegvisomant; or Arm C, low-dose SRL plus daily pegvisomant (15-60 mg/day).

MAIN OUTCOME MEASURE: Monthly treatment cost in each Arm in subjects completing ≥24 weeks of therapy.

RESULTS: Sixty patients were enrolled and 52 evaluable. Fifty of 52 (96%) demonstrated IGF-I control regardless of prior SRL responsiveness (Arm A, 14/15 [93.3%]; Arm B, 22/23 [95.7%]; Arm C, 14/14 [100%]). Arm B was least costly (mean, $9,837±1,375 per month); Arm C was most expensive (mean, $22,543±11,158 per month) and Arm A had an intermediate cost (mean, $14,261±1,645 per month). Approximately 30% required pegvisomant dose uptitration. Rates of adverse events were all <10%.

CONCLUSIONS: Low-dose SRL plus weekly pegvisomant represents a novel dosing option for achieving cost-effective, optimal biochemical control in patients with uncontrolled acromegaly requiring combination therapy.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
32754748
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"