Acromegaly pegvisomant

Pegvisomant is a GH receptor antagonist that is useful for the treatment of acromegaly. Pegvisomant is the polyethylene glycol (PEG) derivative of a mutant GH, B2036, which has increased affinity for one site of the GH receptor but a reduced... 

Pegvisomant is a growth hormone receptor antagonist registered for the treatment of patients with acromegaly who had insufficient benefit from surgery or radiation. 

Pegvisomant Blocks GH receptors Ameliorates effects of excess GH production Acromegaly SC injection 3-7 x/wk Toxicity Increased liver enzymes... 

In 112 patients with active acromegaly who received pegvisomant in a 12 week, randomized, double-blind study of three different daily subcutaneous doses of pegvisomant (10,15, and 20 mg), headache was reported in the placebo group as often as in the active treatment groups (12%) (2). In a longer follow-up study for up to 18 months, 26% of 160 patients had headache, but there was no control group for comparison (3). 

Barkan AL, Burman P, Clemmons DR, Drake WM, Gagel RF, Harris PE, Trainer PJ, van der Lely AJ, Vance ML. Glucose homeostasis and safety in patients with acromegaly converted from long-acting octreotide to pegvisomant. J Clin Endocrinol Metab 2005 90 5684-91. 

Parkinson, C., Kassem, M., Heickendorff, L., et al. PEGvisomant-induced serum insulin-like growth factor-I normalization in patients with acromegaly returns elevated markers of bone turnover to normal. J. Clin. Endocrinol. Metab. 88(12) 5650-5655. 2003. 

Pegvisomant appears to be the most effective agent for normalizing IGF-I concentrations. However, further study is needed to determine the long-term safety and efficacy of this agent for the treatment of acromegaly. 

Trainer PJ, Drake WM, Katznelson L, et al. Treatment of acromegaly with the growth hormone-receptor antagonist Pegvisomant. N Engl J Med 2000 342 1171-1177. 

Van Der Lely AJ, Hutson R, Trainer PJ, et al. Long-term treatment of acromegaly with pegvisomant, a growth hormone receptor antagonist. Lancet 2001 358 1754-1759. 

Anonymous. Pegvisomant (Somavert) for acromegaly. Med Lett Drugs Ther 2003 45 55-56. 

Somavert [pegvisomant recombinant engineered hGH analog (antagonist), produced in E. coli] Pharmacia Enterprises treatment of selected patients suffering from acromegaly 2002 (EU)... 

USA pegvisomant peptide Somavert Trovert Recombinant modified human growth hormone (amino acid substitutions) expressed in E. coli and linked to polyethylene glycol Acromegaly... 

Pegvisomant (Somavert) Pfizer (2002) Human growth hormone antagonist 4-5 PEGofSkDa Acromegaly... 

A 54-year-old woman with acromegaly developed an intense erythematous pruriginous reaction at the site of her 11th daily injection of pegvisomant 10 mg/day. This was associated with a fever (39°C) for 48 hours and similar lesions at the sites of previous injections. She did not have a history of hypersensitivity reactions. A skin biopsy showed edema in the papillary dermis, slight perivascular inflammatory lymphocytic infiltrates, and capillary vasodilatation. The lesions disappeared within 5 days after withdrawal of pegvisomant and use of methylprednisolone 40 mg/day. 

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