PegvisOMant and the Immune SystEm (PROMISE)

Description

This is a prospective observational pilot study for the evaluation of pegvisomant (PEG) treatment on immune function and its implication on insulin resistance, metabolic complications and fat accumulation in patients with acromegaly.

The observational study will concern the collection of data from patients who, as they are not controlled by SSAs therapy (cohort 1), require PEG therapy in monotherapy (group 1) or in combination with SSAs (group 2), according to common clinical practice. The investigators will enroll also acromegaly patients adequately controlled by medical therapy (cohort 2), respectively treated by any kind of SSAs (group 3) and by PEG (group 4) for comparison between different medical treatments. The data will be prospectively collected at baseline and after 4 and 8 weeks of treatment.

The primary outcome will be the immune profiling by quantification of peripheral blood mononuclear cells (PBMC) subpopulations.

Secondary outcome measures will be

• Evaluation of inflammatory cytokines and adipokines production.
• Evaluation of glucose, insulin, c-peptide, HbA1c, triglycerides, total cholesterol, HDL-cholesterol, LDL-cholesterol apolipoprotein B and A. Insulin resistance and cell function will be assessed by the homeostasis model assessment for insulin resistance (HOMA-IR) index and for cell secretion (HOMA-). Anthropometric measurements will include body weight, height and waist and hip circumference.
• Evaluation of peripheral tissue (end-organ) metabolic complications. Composite outcome measure consisting of skeletal muscle and fat distribution analysis.
• Fasting samples from all patients will be assayed for disease control parameters.
• Evaluation of quality of life. Quality of life will be measured by Short Form (SF)-36-Item Health Survey total score, SF-36-Item Health Survey physical component summary score and SF-36-Item Health Survey mental component summary score and Acromegaly quality of life (AcroQol) questionnaire.
• Evaluation of sleep disturbances. Sleep disturbances will be measured by Epworth Sleepiness Scale (ESS) and by polysomnography when appropriate.

Details