New formulations and approaches in the medical treatment of acromegaly

Curr Opin Endocrinol Diabetes Obes. 2010 Aug;17(4):350-5. doi: 10.1097/MED.0b013e32833ab099.

Abstract

Purpose of review: To discuss novel drug formulations being developed for the medical treatment of acromegaly and to highlight recent data from studies reporting more effective therapeutic strategies using existing drugs.

Recent findings: Despite advances in the management of acromegaly a significant number of patients remain uncontrolled. Primary medical treatment is being increasingly considered, but use of somatostatin analogues, the current mainstay of medical therapy, achieves control in only around 60% of patients, whilst 10-20% may be controlled with dopamine agonists. Consequently, improvements in drug efficacy and convenience are needed. Newer longer-acting somatostatin analogues are in development and combination regimes with the growth hormone receptor antagonist, pegvisomant, given at more cost-effective weekly doses show promising results. Somatostatin analogue-resistant tumours may respond to ligands with higher affinities to other receptors, such as pasireotide (SOM 230). Further, the combined dopamine/somatostatin receptor analogue BIM-23A760 has increased affinity to somatostatin receptors 2 and 5 and to the dopamine 2 receptor, and phase 2 clinical studies are underway.

Summary: These novel drugs, formulations and treatment regimes should potentially add to the armamentarium of treatment options for patients with acromegaly.

Publication types

  • Evaluation Study
  • Review

MeSH terms

  • Acromegaly / drug therapy*
  • Acromegaly / etiology
  • Acromegaly / metabolism
  • Adenoma / complications
  • Adenoma / drug therapy
  • Adenoma / metabolism
  • Chemistry, Pharmaceutical / trends*
  • Dose-Response Relationship, Drug
  • Growth Hormone-Secreting Pituitary Adenoma / complications
  • Growth Hormone-Secreting Pituitary Adenoma / drug therapy
  • Growth Hormone-Secreting Pituitary Adenoma / metabolism
  • Hormone Antagonists / administration & dosage
  • Hormone Antagonists / chemical synthesis
  • Hormone Antagonists / therapeutic use*
  • Human Growth Hormone / metabolism
  • Humans
  • Somatostatin / analogs & derivatives*
  • Somatostatin / antagonists & inhibitors

Substances

  • Hormone Antagonists
  • Human Growth Hormone
  • Somatostatin