Table 1: Acromegaly medical therapy.

Variable	Route	Usual dose	Dose schedule	Possible side effects	Efficacy (approx)
Centrally acting agents
Octreotide	SC	50–400 μg/day	1–4 times/day	nausea, vomiting, diarrhoea, constipation, abdominal pain, cholelithiasis/biliary sludge, bloating, bradycardia, fatigue, headache, alopecia, dysglycaemia	30–60% (depending on primary versus. adjuvant therapy, composite endpoint and dose escalation)
Octreotide LAR	IM	20–40 mg	Monthly
Lanreotide	deep SC	60–120 mg	Monthly (4–6 weeks)
Pasireotide LAR	IM	40–60 mg	Monthly	Same as above, with more hyperglycaemia	40%
Cabergoline	Oral	1–4 mg	Bi-weekly up to daily	Nausea, dizziness, orthostatic hypotension	30–40% in mild acromegaly
Oral octreotide (in development, phase III clinical trials)	Oral	40–80 mg	2 times/day	nausea, vomiting, diarrhoea, dyspepsia, cholelithiasis, headaches, dizziness, dysglycaemia	65%
GH receptor blocker
Pegvisomant	SC	10–40 mg	Daily	Transaminases elevation, lipodystrophy, arthralgias	60–90%
Combination therapy
Pegvisomant-SRL (Octreotide or Lanreotide)		PEG 25–160 mg/week LAN 120 mg OCT 30 mg	Daily to Weekly Monthly Monthly		62–100%
Pegvisomant-pasireotide LAR		PEG 21–78 mg PAS 60 mg	Weekly Monthly		68%
Cabergoline-SRL (Octreotide or Lanreotide)		CAB 1–3.5 mg/week OCT 30 mg LAN 60–90 mg	Bi-weekly Monthly Monthly		30–56%
Cabergoline-pegvisomant		CAB 1–3.5 mg/week PEG 10–30 mg/day	Bi-weekly Daily		13–28%

CAB = cabergoline; GH = growth hormone; IM = intramuscular; LAN = lanreotide; LAR = long-acting release; OCT = octreotide; PAS = pasireotide; PEG = pegvisomant; SC = subcutaneous; SRL = somatostatin receptor ligand. Adapted from Langlois et al, 2017.⁵⁷