A multivariable prediction model for pegvisomant dosing: Monotherapy and in combination with long-acting somatostatin analogues

S. E. Franck, T. I.M. Korevaar, P. Petrossians, A. F. Daly, P. Chanson, Marie Lise Jaffrain-Rea, T. Brue, G. K. Stalla, D. Carvalho, A. Colao, V. Hána, B. Delemer, C. Fajardo, A. J. Van Der Lely, A. Beckers, S. J.C.M.M. Neggers

Research output: Contribution to journalArticle

Abstract

Background: Effective treatment of acromegaly with pegvisomant (PEGV), a growth hormone receptor antagonist, requires an appropriate dose titration. PEGV doses vary widely among individual patients, and various covariates may affect its dosing and pharmacokinetics. Objective: To identify predictors of the PEGV dose required to normalize insulin-like growth factor I (IGF-I) levels during PEGV monotherapy and in combination with long-acting somatostatin analogues (LA-SSAs). Design: Two retrospective cohorts (Rotterdam + Liège Acromegaly Survey (LAS), total n = 188) were meta-analyzed as a form of external replication to study the predictors of PEGV dosing in addition to LA-SSA, the LAS (n = 83) was used to study the predictors of PEGV monotherapy dosing. Multivariable regression models were used to identify predictors of the PEGV dose required to normalize IGF-I levels. Results: For PEGV dosing in combination with LA-SSA, IGF-I levels, weight, height and age, were associated with the PEGV normalization dosage (P ≤ 0.001, P ≤ 0.001, P = 0.028 and P = 0.047 respectively). Taken together, these characteristics predicted the PEGV normalization dose correctly in 63.3% of all patients within a range of ±60 mg/week (21.3% within a range of ±20 mg/week). For monotherapy, only weight was associated with the PEGV normalization dose (P ≤ 0.001) and predicted this dosage correctly in 77.1% of all patients within a range of ±60 mg/week (31.3% within a range of ±20 mg/week). Conclusion: In this study, we show that IGF-I levels, weight, height and age can contribute to define the optimal PEGV dose to normalize IGF-I levels in addition to LA-SSA. For PEGV monotherapy, only the patient's weight was associated with the IGF-I normalization PEGV dosage.

Original languageEnglish
Pages (from-to)421-431
Number of pages11
JournalEuropean Journal of Endocrinology
Volume176
Issue number4
DOIs
Publication statusPublished - Apr 1 2017

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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    Franck, S. E., Korevaar, T. I. M., Petrossians, P., Daly, A. F., Chanson, P., Jaffrain-Rea, M. L., Brue, T., Stalla, G. K., Carvalho, D., Colao, A., Hána, V., Delemer, B., Fajardo, C., Van Der Lely, A. J., Beckers, A., & Neggers, S. J. C. M. M. (2017). A multivariable prediction model for pegvisomant dosing: Monotherapy and in combination with long-acting somatostatin analogues. European Journal of Endocrinology, 176(4), 421-431. https://doi.org/10.1530/EJE-16-0956