Cost-Effectiveness and Efficacy of a Novel Combination Regimen in Acromegaly: A Prospective, Randomized Trial

Vivien Bonert, James Mirocha, John Carmichael, Kevin C.J. Yuen, Takako Araki, Shlomo Melmed

Research output: Contribution to journalReview articlepeer-review

Abstract

Context: Combination therapy with somatostatin receptor ligand (SRL) plus pegvisomant for patients with acromegaly is recommended after a maximizing dose on monotherapy. Lower-dose combination regimens are not well studied. Objective: To compare cost-effectiveness and efficacy of 3 lower-dose combination regimens in controlled and uncontrolled acromegaly Design and Setting: Prospective, randomized, open-label, parallel arm study at a tertiary referral pituitary center. Patients: Adults with acromegaly regardless of response to prior SRL and biochemical control status at baseline, stratified by an SRL dose required for insulin-like growth factor (IGF)-I normalization during any 3-month period within 12 months preceding enrollment. Intervention: Combination therapy for 24 to 32 weeks on arm A, high-dose SRL (lanreotide 120 mg/octreotide long-acting release [LAR] 30 mg) plus weekly pegvisomant (40-160 mg/week); arm B, low-dose SRL (lanreotide 60 mg/octreotide LAR 10 mg) plus weekly pegvisomant; or arm C, low-dose SRL plus daily pegvisomant (15-60 mg/day) Main Outcome Measure: Monthly treatment cost in each arm in participants completing ≥ 24 weeks of therapy. Results: Sixty patients were enrolled and 52 were evaluable. Fifty of 52 (96%) demonstrated IGF-I control regardless of prior SRL responsiveness (arm A, 14/15 [93.3%]; arm B, 22/23 [95.7%]; arm C, 14/14 [100%]). Arm B was least costly (mean, $9837 ± 1375 per month), arm C was most expensive (mean, $22543 ± 11158 per month), and arm A had an intermediate cost (mean, $14261 ± 1645 per month). Approximately 30% of patients required pegvisomant dose uptitration. Rates of adverse events were all < 10%. Conclusions: Low-dose SRL plus weekly pegvisomant represents a novel dosing option for achieving cost-effective, optimal biochemical control in patients with uncontrolled acromegaly requiring combination therapy.

Original languageEnglish (US)
Pages (from-to)E3236-E3245
JournalJournal of Clinical Endocrinology and Metabolism
Volume105
Issue number9
DOIs
StatePublished - Sep 1 2020

Bibliographical note

Funding Information:
Pfizer Inc. (WS2036536) provided financial support for conducting this investigator-initiated trial in the form of providing pegvisomant and contributing to out-of-pocket patient care costs, and was consulted on study design. Support was also provided by the Doris Factor Molecular Endocrinology Laboratory at Cedars-Sinai. Funding sources had no role in data collection, analysis, and interpretation, decision to publish, or preparation of the manuscript.

Keywords

  • Acromegaly
  • Combination therapy
  • Pegvisomant
  • Somatostatin receptor ligand

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Randomized Controlled Trial

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