ometendoОжирение и метаболизмObesity and metabolism2071-87132306-5524Endocrinology Research Centre10.14341/omet13259ometendo-13259Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESОтечественный опыт применения пэгвисоманта при акромегалии (многоцентровое ретроспективное исследование)A retrospective multicenter study of pegvisomant use in acromegaly within Russian Federationhttps://orcid.org/0000-0001-9119-2447ПржиялковскаяЕ. Г.PrzhyalkovskayaE. G.

Пржиялковская Елена Георгиевна - к.м.н.

Москва

Elena G. Przhiyalkovskaya - MD, PhD.

Moscow

przhiyalkovskaya@endocrincentr.ruhttps://orcid.org/0009-0006-4490-8880ФилькинаЕ. Е.FilkinaE. E.

Филькина Екатерина Евгеньевна - клинический ординатор.

Москва

Ekaterina E. Filkina - clinical resident.

Moscow

katia.v.e@mail.ruhttps://orcid.org/0000-0001-5824-6490ПерепеловаМ. А.PerepelovaM. A.

Перепелова Маргарита Александровна – аспирант.

117292, Москва, ул. Дм. Ульянова, д. 11

Margarita A. Perepelova - MD, postgraduate student.

11 Dm. Ulyanova street, 117292 Moscow

margo.doktor@mail.ruhttps://orcid.org/0000-0001-6094-3623ПронинЕ. В.ProninE. V.

Пронин Евгений Вячеславович

Москва

Пронин Евгений Вячеславович

Москва

proninev@zdrav.mos.ruhttps://orcid.org/0000-0003-3261-7366ИловайскаяИ. А.IlovayskayaI. A.

Иловайская Ирэна Адольфовна - д.м.н., доцент.

Москва

Irena A. Ilovaуskaya - Doctor of Medical Science, Рrofessor.

Moscow

irena.ilov@yandex.ruhttps://orcid.org/0000-0002-7033-0545КукушкинаЮ. А.KukushkinaYu. A.

Кукушкина Юлия Александровна

Москва

Yulia A. Kukushkina

Moscow

ulya_uhanova95@mail.ruhttps://orcid.org/0000-0003-2373-8043МихайловаД. С.MikhailovaD. S.

Михайлова Дарья Сергеевна - ст.н.с.

Москва

Daria S. Mikhailova

Moscow

d.s.mikhaylova@mail.ruhttps://orcid.org/0000-0002-0327-4619ДзерановаЛ. К.DzeranovaL. K.

Дзеранова Лариса Константиновна - д.м.н., профессор.

Москва

Larisa K. Dzeranova - MD, Sc.D., Professor.

Moscow

dzeranovalk@yandex.ruhttps://orcid.org/0000-0001-6539-466XПигароваЕ. А.PigarovaE. A.

Пигарова Екатерина Александровна - д.м.н.

Москва

Ekaterina A. Pigarova - MD, PhD.

Moscow

kpigarova@gmail.comhttps://orcid.org/0000-0002-6674-6441БелаяЖ. Е.BelayaZh. E.

Белая Жанна Евгеньевна - д.м.н., профессор.

Москва

Zhanna E. Belaya - MD, PhD, Professor.

Moscow

jannabelaya@gmail.comhttps://orcid.org/0000-0002-9944-2997АнциферовМ. Б.AntsiferovM. B.

Анциферов Михаил Борисович - д.м.н., профессор.

Москва

Mikhail B. Antsiferov - MD, PhD, Professor.

Moscow

antsiferov@rambler.ruhttps://orcid.org/0000-0003-0066-845XАлексееваТ. М.AlekseevaT. M.

Алексеева Татьяна Марковна

Москва

Tatiana M. Alekseeva

Moscow

mamamarka@yandex.ruhttps://orcid.org/0000-0002-9717-9742МокрышеваН. Г.MokryshevaN. G.

Мокрышева Наталья Георгиевна - д.м.н., профессор.

Москва

Natalia G. Mokrysheva - MD, PhD, Professor.

Moscow

mokrisheva.natalia@endocrincentr.ruФГБУ «НМИЦ эндокринологии им. академика И.И. Дедова» Минздрава РоссииРоссияI.I. Dedov National Medical Research Center of EndocrinologyRussian FederationГБУЗ «Эндокринологический диспансер» департамента здравоохранения города МосквыРоссияEndocrinology Dispensary of the Moscow Department of HealthRussian FederationГБУЗ МО МОНИКИ им. М.Ф. ВладимирскогоРоссияMoscow Regional Clinical Research Institute named after M.F. VladimirskyRussian Federation20250309202522297110Copyright © Пржиялковская Е.Г., Филькина Е.Е., Перепелова М.А., Пронин Е.В., Иловайская И.А., Кукушкина Ю.А., Михайлова Д.С., Дзеранова Л.К., Пигарова Е.А., Белая Ж.Е., Анциферов М.Б., Алексеева Т.М., Мокрышева Н.Г., 20252025Пржиялковская Е.Г., Филькина Е.Е., Перепелова М.А., Пронин Е.В., Иловайская И.А., Кукушкина Ю.А., Михайлова Д.С., Дзеранова Л.К., Пигарова Е.А., Белая Ж.Е., Анциферов М.Б., Алексеева Т.М., Мокрышева Н.Г.Przhyalkovskaya E.G., Filkina E.E., Perepelova M.A., Pronin E.V., Ilovayskaya I.A., Kukushkina Y.A., Mikhailova D.S., Dzeranova L.K., Pigarova E.A., Belaya Z.E., Antsiferov M.B., Alekseeva T.M., Mokrysheva N.G.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.omet-endojournals.ru/jour/article/view/13259Введение

Введение. Акромегалия является хроническим нейроэндокринным заболеванием, жизненный прогноз которого зависит от своевременного и адекватного лечения. Высокий процент нерадикального хирургического лечения, проблема резистентности к медикаментозной терапии первой линии диктуют необходимость своевременного подключения препаратов второй линии.

Цель исследования

Цель исследования. Оценка эффективности и безопасности терапии пэгвисомантом (ПЭГ) у больных с неудовлетворительным контролем акромегалии.

Методы

Методы. Проанализированы особенности и результаты лечения 185 пациентов с акромегалией, не достигших биохимической ремиссии на фоне терапии аналогами соматостатина, получающих терапию ПЭГ, назначенную на базе 3 медицинских центров Российской Федерации г. Москвы в период с 2019 по 2024 гг. На фоне лечения проводился динамический контроль уровня инсулиноподобного фактора роста 1 (ИФР-1), показателей углеводного обмена, печеночных трансаминаз, магнитно-резонансной томографии головного мозга с контрастным усилением.

Результаты

Результаты. На фоне лечения ПЭГ у 70,8% пациентов была достигнута стойкая биохимическая ремиссия акромегалии. Средняя суточной доза ПЭГ составила 15 мг. Установлена прямая зависимость дозы препарата от исходного уровня ИФР-1, индекса массы тела и уровня гликированного гемоглобина. Применение препарата не сопровождалось значимым изменением размеров аденомы гипофиза и развитием серьезных нежелательных явлений.

Заключение

Заключение. Своевременное включение препарата 2-й линии (ПЭГ) в лечебную схему пациентов, не достигших контроля на фоне высокодозной монотерапии аналогами соматостатина, позволяет достигнуть стойкого биохимического контроля акромегалии при минимальных побочных эффектах.

BACKGROUND

BACKGROUND: Acromegaly is a chronic neuroendocrine disorder, the prognosis of which depends on timely and adequate treatment. A high percentage of non-radical surgical treatment and the problem of resistance to first-line drug therapy necessitate the timely inclusion of second-line drugs.

AIM

AIM: To evaluate the efficacy and safety of pegvisomant (PEG) therapy in patients with unsatisfactory acromegaly control.

MATERIALS AND METHODS

MATERIALS AND METHODS: The characteristics and treatment outcomes of 185 patients with acromegaly who did not achieve biochemical remission with somatostatin analogs were analyzed. These patients received PEG therapy at three medical centers in Moscow, Russia, between 2019 and 2024. During treatment, dynamic monitoring of insulin-like growth factor 1 (IGF-1) levels, carbohydrate metabolism indicators, liver transaminases, and contrast-enhanced magnetic resonance imaging (MRI) of the brain were performed.

RESULTS

RESULTS: PEG treatment resulted in sustained biochemical remission of acromegaly in 70.8% of patients. The average daily PEG dose was 15 mg. A direct relationship was established between the drug dose and the initial IGF-1 level, body mass index (BMI), and glycated hemoglobin level. The use of the drug was not associated with significant changes in pituitary adenoma size or the development of serious adverse events.

CONCLUSION

CONCLUSION: Timely inclusion of a second-line drug (PEG) in the treatment regimen of patients who did not achieve control with high-dose monotherapy with somatostatin analogs allows for achieving sustained biochemical control of acromegaly with minimal side effects.

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