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- Title
Pegvisomant Improves Glucose Metabolism in Acromegaly: A Meta-Analysis of Prospective Interventional Studies.
- Authors
Feola, Tiziana; Cozzolino, Alessia; Simonelli, Ilaria; Sbardella, Emilia; Pozza, Carlotta; Giannetta, Elisa; Gianfrilli, Daniele; Pasqualetti, Patrizio; Lenzi, Andrea; Isidori, Andrea M
- Abstract
<bold>Introduction: </bold>Pegvisomant (PEG) in monotherapy or combined with somatostatin analogs (SSAs) is used to control acromegaly, improving metabolism. However, the metabolic changes induced by PEG have not been systematically reviewed.<bold>Objective: </bold>To address the following questions: does PEG or the combination of PEG and SSAs affect fasting plasma glucose (FPG), glycosylated Hb (HbA1c), glucose load (2-hour oral glucose tolerance test), insulin levels [fasting plasma insulin (FPI)], homeostatic model assessment of insulin resistance (HOMA-I), homeostatic model assessment of β-cell function, lipid profile, or body mass index? Are the effects disease-related or drug-related?<bold>Data Sources: </bold>Indexed databases up to January 2019.<bold>Study Selection: </bold>Prospective interventional trials reporting glycometabolic outcomes under PEG or PEG plus SSAs for a minimum of 6 months.<bold>Data Extraction: </bold>Three reviewers screened eligible publications (7248), three others extracted the outcomes, and all assessed the risk of biases.<bold>Data Synthesis: </bold>Thirteen studies were included in the PEG and 5 in the PEG plus SSAs analysis (overall 550 subjects). PEG significantly decreased FPG [effect size (ES) -0.80 mmol/L (95% CI, -1.06 to -0.55); P = 0.000], HbA1c [ES -0.43% (95% CI, -0.56 to -0.31); P = 0.000], FPI [ES -5.31 mU/L (95% CI, -10.23 to -0.39); P = 0.034], and HOMA-I [ES -0.61 (95% CI, -1.17 to -0.04); P = 0.034]. Effects on FPG and FPI were not correlated to IGF-1 changes. The addition of PEG to SSAs mitigated the effects of SSAs on metabolism, producing an overall neutral effect.<bold>Conclusions: </bold>Independently of disease control, PEG in monotherapy or combined with SSAs seems to improve glucose metabolism, reducing FPG, HbA1c, FPI, and HOMA-I.
- Subjects
GLYCOSYLATED hemoglobin; GLUCOSE metabolism
- Publication
Journal of Clinical Endocrinology & Metabolism, 2019, pN.PAG
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/jc.2018-02281