Bone health and skeletal fragility in second- and third-line medical therapies for acromegaly: preliminary results from a pilot single center experience.

IF 3.3 2区医学 Q2 ENDOCRINOLOGY & METABOLISM Pituitary Pub Date : 2024-06-01 Epub Date: 2024-05-07 DOI:10.1007/s11102-024-01398-9

Sabrina Chiloiro, Antonella Giampietro, Amato Infante, Pier Paolo Mattogno, Liverana Lauretti, Alessandro Olivi, Laura De Marinis, Alfredo Pontecorvi, Francesco Doglietto, Antonio Bianchi

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Abstract

Introduction: Skeletal fragility is a clinically relevant and not-reversible complication of acromegaly, involving around 30-40% of patients since the disease diagnosis. Few studies have investigated the effects on skeletal health of medical therapies for acromegaly. In this retrospective longitudinal monocentre study, we investigated the outcome of skeletal fragility in patients treated with Pasireotide Lar in combination with Pegvisomant (Pasi-Lar + Peg-V), also comparing those observed in patients treated with conventional therapies.

Results: We included 6 patients treated with Pasi-Lar + Peg-V, 5 patients treated with Peg-V in monotherapy (m-Peg-V), 16 patients treated with Peg-V plus first-generation somatostatin receptor ligands (fg-SRLs + Peg-V), 9 patients treated with Pasi-Lar. None of the patients treated with Pasi-Lar + Peg-V experienced worsening of spine and femoral bone mineral density (BMD) and incident vertebral fractures (i-VFs). Eight patients experienced i-VFs. The frequency of i-VFs was significantly lower in patients treated with the Pasi-Lar + Peg-V (0/8; 0%), as compared to those observed in m-Peg-V treated patients (4/8; 50%, p = 0.02). The frequency of i-VFs was slightly but not significantly higher in Pasi-Lar treated patients (1/8; 12.5% p = 0.6) and in fg-SRLs + Peg-V treated patients (3/8; 37.5% p = 0.364), concerning those treated with Pasi-Lar + Peg-V (0/8; 0%). I-VFs occurred more frequently in patients with higher GH levels at acromegaly diagnosis (p < 0.001), and in patients who experienced a BMD worsening (p = 0.005).

Conclusion: Our preliminary data suggested that in conventional and multi-drug resistant acromegaly, the combination therapy Pasi-Lar + Peg-V may prevent the worsening of BMD and the occurrence of i-VFs. Prospective and translational studies should further validate these results and ascertain underlying physiopathology mechanisms.

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肢端肥大症二线和三线药物治疗中的骨骼健康和骨骼脆性：单中心试点经验的初步结果。

简介骨骼脆性是肢端肥大症的一种临床相关且不可逆转的并发症，自疾病确诊以来，约有 30%-40% 的患者会出现骨骼脆性。很少有研究调查肢端肥大症药物疗法对骨骼健康的影响。在这项回顾性纵向单中心研究中，我们调查了帕西瑞罗肽拉尔与培维索孟联合疗法（帕西拉尔+培维索孟）治疗患者的骨骼脆性结果，并对传统疗法治疗患者的骨骼脆性结果进行了比较：我们纳入了 6 名接受帕西拉尔 + Peg-V 治疗的患者、5 名接受 Peg-V 单一疗法（m-Peg-V）治疗的患者、16 名接受 Peg-V 加第一代体生长抑素受体配体（fg-SRLs + Peg-V）治疗的患者、9 名接受帕西拉尔治疗的患者。在接受 Pasi-Lar + Peg-V 治疗的患者中，没有人出现脊柱和股骨骨矿物质密度（BMD）恶化以及椎体骨折（i-VFs）事件。8名患者出现了i-VFs。与接受 m-Peg-V 治疗的患者（4/8；50%，p = 0.02）相比，接受 Pasi-Lar + Peg-V 治疗的患者发生 iVFs 的频率明显降低（0/8；0%）。接受 Pasi-Lar 治疗的患者（1/8；12.5% p = 0.6）和接受 fg-SRLs + Peg-V 治疗的患者（3/8；37.5% p = 0.364）出现 i-VFs 的频率略高，但并不明显，而接受 Pasi-Lar + Peg-V 治疗的患者（0/8；0%）出现 i-VFs 的频率更高。在确诊肢端肥大症时 GH 水平较高的患者中，I-VF 的发生率更高（P我们的初步数据表明，对于传统和耐多药的肢端肥大症患者，Pasi-Lar + Peg-V 联合疗法可预防 BMD 恶化和 i-VFs 的发生。前瞻性和转化性研究应进一步验证这些结果，并确定潜在的生理病理机制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pituitary 医学-内分泌学与代谢

CiteScore

7.10

自引率

7.90%

发文量

审稿时长

6 months

期刊介绍： Pituitary is an international publication devoted to basic and clinical aspects of the pituitary gland. It is designed to publish original, high quality research in both basic and pituitary function as well as clinical pituitary disease. The journal considers: Biology of Pituitary Tumors Mechanisms of Pituitary Hormone Secretion Regulation of Pituitary Function Prospective Clinical Studies of Pituitary Disease Critical Basic and Clinical Reviews Pituitary is directed at basic investigators, physiologists, clinical adult and pediatric endocrinologists, neurosurgeons and reproductive endocrinologists interested in the broad field of the pituitary and its disorders. The Editorial Board has been drawn from international experts in basic and clinical endocrinology. The journal offers a rapid turnaround time for review of manuscripts, and the high standard of the journal is maintained by a selective peer-review process which aims to publish only the highest quality manuscripts. Pituitary will foster the publication of creative scholarship as it pertains to the pituitary and will provide a forum for basic scientists and clinicians to publish their high quality pituitary-related work.