Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
Medical Statistics and Information Technology, AFaR-Fatebenefratelli Hospital, Rome, Italy.
J Clin Endocrinol Metab. 2019 Jul 1;104(7):2892-2902. doi: 10.1210/jc.2018-02281.
Pegvisomant (PEG) in monotherapy or combined with somatostatin analogs (SSAs) is used to control acromegaly, improving metabolism. However, the metabolic changes induced by PEG have not been systematically reviewed.
To address the following questions: does PEG or the combination of PEG and SSAs affect fasting plasma glucose (FPG), glycosylated Hb (HbA1c), glucose load (2-hour oral glucose tolerance test), insulin levels [fasting plasma insulin (FPI)], homeostatic model assessment of insulin resistance (HOMA-I), homeostatic model assessment of β-cell function, lipid profile, or body mass index? Are the effects disease-related or drug-related?
Indexed databases up to January 2019.
Prospective interventional trials reporting glycometabolic outcomes under PEG or PEG plus SSAs for a minimum of 6 months.
Three reviewers screened eligible publications (7248), three others extracted the outcomes, and all assessed the risk of biases.
Thirteen studies were included in the PEG and 5 in the PEG plus SSAs analysis (overall 550 subjects). PEG significantly decreased FPG [effect size (ES) -0.80 mmol/L (95% CI, -1.06 to -0.55); P = 0.000], HbA1c [ES -0.43% (95% CI, -0.56 to -0.31); P = 0.000], FPI [ES -5.31 mU/L (95% CI, -10.23 to -0.39); P = 0.034], and HOMA-I [ES -0.61 (95% CI, -1.17 to -0.04); P = 0.034]. Effects on FPG and FPI were not correlated to IGF-1 changes. The addition of PEG to SSAs mitigated the effects of SSAs on metabolism, producing an overall neutral effect.
Independently of disease control, PEG in monotherapy or combined with SSAs seems to improve glucose metabolism, reducing FPG, HbA1c, FPI, and HOMA-I.
培维索孟（PEG）单药或与生长抑素类似物（SSA）联合用于控制肢端肥大症，改善代谢。然而，PEG 引起的代谢变化尚未得到系统评价。
解决以下问题：PEG 或 PEG 和 SSA 联合治疗是否会影响空腹血糖（FPG）、糖化血红蛋白（HbA1c）、葡萄糖负荷（口服 2 小时葡萄糖耐量试验）、胰岛素水平[空腹血浆胰岛素（FPI）]、稳态模型评估的胰岛素抵抗（HOMA-I）、稳态模型评估的β细胞功能、血脂谱或体重指数？这些影响是与疾病相关还是与药物相关？
截至 2019 年 1 月的索引数据库。
前瞻性干预性试验，报告 PEG 或 PEG 联合 SSA 治疗至少 6 个月后的糖代谢结果。
三名评审员筛选合格出版物（7248 篇），另外三名评审员提取结果，所有评审员评估偏倚风险。
13 项 PEG 研究和 5 项 PEG 联合 SSA 研究纳入分析（共 550 例受试者）。PEG 显著降低 FPG[效应量（ES）-0.80mmol/L（95%CI，-1.06 至-0.55）；P=0.000]、HbA1c[ES-0.43%（95%CI，-0.56 至-0.31）；P=0.000]、FPI[ES-5.31mU/L（95%CI，-10.23 至-0.39）；P=0.034]和 HOMA-I[ES-0.61（95%CI，-1.17 至-0.04）；P=0.034]。FPG 和 FPI 的变化与 IGF-1 变化不相关。PEG 联合 SSA 可减轻 SSA 对代谢的影响，产生总体中性效应。
PEG 单药或与 SSA 联合治疗独立于疾病控制，似乎可改善葡萄糖代谢，降低 FPG、HbA1c、FPI 和 HOMA-I。
