Pegvisomant: uso clínico en pacientes con acromegalia

Contexto: el manejo de los pacientes con acromegalia actualmente incluye cirugía, radioterapia y terapia farmacológica. Aunque la cirugía es el tratamiento de primera línea, un gran porcentaje de pacientes van a requerir manejo adicional con radioterapia y farmacoterapia.

Objetivo: revisar las características farmacológicas y los estudios clínicos de pegvisomant.

Metodología: se revisaron las bases de datos electrónicas como Medline y Pubmed con el término pegvisomant y se analizaron los estudios clínicos y los datos relevantes de este medicamento en el manejo de acromegalia.

Resultados: los análogos de somatostatina constituyen el tratamiento farmacológico de primera línea indicado en las guías de práctica la de esta entidad, no obstante, estudios recientes han reportado niveles muy variables de control de la enfermedad. Para lograr un mejor control se introdujo el pegvisomant, un análogo de la hormona de crecimiento que se une al receptor pero no induce cambios conformacionales para la transducción de señales y, por tanto, no inhibe la secreción de la hormona de crecimiento, sino sus efectos fisiológicos en los tejidos diana. Hasta la fecha, ha demostrado eficacia para normalizar los niveles séricos del IGF-1 tanto en monoterapia como en terapia combinada.

Conclusiones: si no logramos el control de la enfermedad a pesar de estos medicamentos, debemos considerar terapias de segunda línea como pasireotide o pegvisomant. Las características clínicas individuales del paciente permitirán elegir cuál es la mejor opción para nuestros pacientes. El pegvisomant es un medicamento eficaz para el control del paciente con acromegalia.

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pegvisomant
acromegalia
antagonista de GH
IGF-1
lanreotide
octreotide
pasireotide