medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-7-137-144medsovet-5665Research ArticleДРУГИЕ ПРОБЛЕМЫ ЭНДОКРИНОЛОГИИOTHER PROBLEMS OF ENDOCRINOLOGYНовые возможности вторичной медикаментозной терапии акромегалииNew opportunities for secondary drug therapy of acromegalyhttps://orcid.org/0000-0001-5045-798XПронинВ. С.ProninV. S.

Пронин Вячеслав Сергеевич, д.м.н., профессор кафедры эндокринологии 

125993, Россия, Москва, ул. Баррикадная, д. 2/1, стр. 1

Vyacheslav S. Pronin, Dr. of Sci. (Med.), Professor of Endocrinology Department

2/1, b. 1, Barrikadnaya St., Moscow, 125993, Russia

vspronin@yandex.ruhttps://orcid.org/0000-0001-6094-3623ПронинЕ. В.ProninE. V.

Пронин Евгений Вячеславович, врач-эндокринолог

119034, Россия, Москва, ул. Пречистенка, д. 37, стр. 1

Evgeny V. Pronin, endocrinologist

37, bld. 1, Prechistenka St., Moscow, 119034, Russia

r-wp@mail.ruРоссийская медицинская академия непрерывного профессионального образованияРоссияRussian Medical Academy of Continuing Professional EducationRussian FederationЭндокринологический диспансерРоссияEndocrinology DispensaryRussian Federation20202805202007137144Copyright © Пронин В.С., Пронин Е.В., 20202020Пронин В.С., Пронин Е.В.Pronin V.S., Pronin E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5665Введение

Введение. Акромегалия является тяжелым полиорганным заболеванием, негативно влияющим на качество и продолжительность жизни пациентов. Сохраняющаяся сложность курации акромегалии обусловлена множественностью патоморфологических вариантов гормон роста секретирующих аденом и отсутствием дифференцированного подхода при выборе лечебной стратегии. Высокий процент нерадикальной аденомэктомии, обусловленный большими размерами и инвазивным ростом соматотропином, предполагает оперативное подключение адекватной вторичной медикаментозной терапии.

Целью исследования является проведение сравнительного анализа эффективности различных классов лекарственных препаратов, а также алгоритмов их комбинированного использования при лечении акромегалии.

Методы лечения

Методы лечения. В обзоре использованы сведения о факторах, влияющих на результаты клинического использования современных фармакологических препаратов (аналогов соматостатина, агонистов дофамина, антагонистов рецепторов гормона роста), использующихся при вторичной медикаментозной терапии акромегалии. Обсуждаются показания для назначения того или иного препарата с учетом особенностей патоморфологического строения опухолевой ткани, а также тактика лечебного пособия при абсолютной или относительной резистентности к аналогам соматостатина 1-й генерации (октреотиду и ланреотиду) и агонистам дофамина (каберголину). Суммированы сведения об эффективности нового препарата – пэгвисоманта, обеспечивающего стойкий контроль акромегалии независимо от секреторной активности и рецепторного фенотипа опухолевой ткани.

Результаты

Результаты. Представлены промежуточные отчеты обсервационного наблюдательного проекта ACROSTUDY и других клинических исследований относительно терапевтической эффективности и безопасности пэгвисоманта. Показан относительно низ- кий риск продолженного роста опухолевой ткани и других побочных реакций на фоне лечения этим препаратом. К прогностическим факторам недостаточной эффективности пэгвисоманта относятся молодой возраст, повышенный ИМТ, высокий исходный уровень ИРФ-1, наличие сахарного диабета. Отмечается преимущество комбинированного использования пэгвисоманта и аналогов соматостатина для поддержания контроля акромегалии и профилактики опухолевого роста. Затрагивается тема первичной терапии пэгвисомантом. По итогам реальной клинической практики представлены современные международные рекомендации, в которых обозначено место пэгвисоманта в алгоритме вторичной медикаментозной терапии.

Выводы

Выводы. Благодаря внедрению в клиническую практику разнонаправленных лечебных средств, позволяющих независимо от активности заболевания, специфики патоморфологического строения опухолевой ткани и соматического статуса добиться стойкого поддержания биохимической ремиссии у пациентов, появились реальные возможности для повышения качества и продолжительности жизни.

Introduction

Introduction. Acromegaly is a severe multi-organ disease that negatively affects the quality and life expectancy of patients. The continuing complexity of acromegaly curation is due to the multiplicity of pathomorphological variants growth hormone-secreting adenomas and the lack of differentiated approach in choosing a therapeutic strategy. The high percentage of non-radical adenomectomy, due to the large size and invasive growth of somatotropin, involves the operative connection of adequate secondary drug therapy.

Purpose

Purpose. The aim of the study is to compare the effectiveness of different classes of drugs, as well as algorithms of their combined use in the treatment of acromegaly.

Methods of treatment

Methods of treatment. The review uses information on factors affecting the results of clinical use of modern pharmacological preparations (somatostatin analogues, dopamine agonists, growth hormone receptor antagonists) used in secondary drug therapy of acromegaly. The indications for the administration of a drug are discussed taking into account the features of the pathomorphological structure of the tumor tissue, as well as the tactics of the therapeutic allowance in absolute or relative resistance to somatostatin analogues of the 1st generation (octreotide and lanreotide) and dopamine agonists (cabergoline). Data on efficiency of the new drug – pegvisomant providing stable control of acromegaly irrespective of secretory activity and receptor phenotype of tumor tissue are summed up.

Results

Results. Interim reports of the ACROSTUDY observational project and other clinical studies regarding the therapeutic efficacy and safety of pegvisomant are presented. A relatively low risk of continued growth of tumor tissue and other adverse reactions against the background of treatment with this drug is shown. Prognostic factors of insufficient efficiency of pegvisomant include young age, increased BMI, high initial level of ИРФ-1, presence of diabetes mellitus. There is an advantage of combined use of pegvisomant and somatostatin analogues to maintain acromegaly control and prevent tumor growth. The topic of primary therapy of pegvisomant is touched upon. Based on the results of real clinical practice, modern international recommendations are presented, which indicate the place of pegvisomant in the algorithm of secondary drug therapy.

Conclusions

Conclusions. Due to the introduction into clinical practice of various therapeutic agents, which allow, regardless of the activity of the disease, the specificity of the pathomorphological structure of tumor tissue and somatic status, to achieve stable maintenance of biochemical remission, patients have real opportunities for improving the quality and life expectancy.

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The authors declare that there are no conflicts of interest present.