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Cost-Effectiveness and Efficacy of a Novel Combination Regimen in Acromegaly: A Prospective, Randomized Trial
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Cost-Effectiveness and Efficacy of a Novel Combination Regimen in Acromegaly: A Prospective, Randomized Trial
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Journal Article
Cost-Effectiveness and Efficacy of a Novel Combination Regimen in Acromegaly: A Prospective, Randomized Trial
2020
Overview
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.
Publisher
Oxford University Press
Subject
/ Adult
/ Dosage
/ Dose-Response Relationship, Drug
/ Drug Administration Schedule
/ Drug Therapy, Combination - adverse effects
/ Drug Therapy, Combination - economics
/ Female
/ Human Growth Hormone - administration & dosage
/ Human Growth Hormone - adverse effects
/ Human Growth Hormone - analogs & derivatives
/ Human Growth Hormone - economics
/ Humans
/ Insulin
/ Insulin-like growth factor I
/ Male
/ Octreotide - administration & dosage
/ Octreotide - adverse effects
/ Peptides, Cyclic - administration & dosage
/ Peptides, Cyclic - adverse effects
/ Peptides, Cyclic - economics
/ Receptors, Somatostatin - agonists
/ Somatostatin - administration & dosage
/ Somatostatin - adverse effects
/ Somatostatin - analogs & derivatives
/ Therapies, Investigational - adverse effects
/ Therapies, Investigational - economics
