Glucose metabolism outcomes in acromegaly patients on treatment with pasireotide-LAR or pasireotide-LAR plus Pegvisomant

Sabrina Chiloiro,Federica Mirra,Alfredo Pontecorvi,Federico Donfrancesco,Antonella Giampietro,Laura De Marinis,Felicia Visconti,Cara M Fleseriu,Andrea Giustina,Maria Fleseriu,Laura Rossi,Antonio Bianchi

doi:10.1007/s12020-021-02711-3

Abstract

IntroductionDisorders of glucose metabolism are a serious acromegaly comorbidity and may be differently impacted by medical treatments of acromegaly. In this retrospective longitudinal multicenter study, we investigated the outcome of glucose metabolism and its predictors in patients treated with Pasireotide LAR (PAS-LAR) alone or in combination with Pegvisomant (PAS-LAR + Peg-V).Subjects and methodsAcromegaly patients treated continously with PAS-LAR or PAS-LAR + Peg-V for at least 6 months.ResultsForty patients (25 females, 15 males) were enrolled. At last visit, 27/40 patients (67.5%) reached biochemical control of acromegaly. Overall, glucose metabolism improved in 3 (all in PAS-LAR + Peg-V; 7.5%), worsened in 26 (65%) and remained unchanged in 11 patients (27.5%). Glucose metabolism worsened in 25 patients (73.5%) treated with PAS-LAR and in a single patient (16.7%) treated with PAS-LAR + Peg-V (p < 0.001). Among patients treated with Pas-LAR alone, GH at baseline was higher in those with worsening of glucose metabolism (p = 0.04) as compared to those with stable glucose status. A significantly higher reduction of HbA1c was observed in patients treated with PAS-LAR + Peg-V, as compared with those treated with PAS-LAR alone (p = 0.005).ConclusionsOur data confirmed that glucose metabolism in patients treated with PAS-LAR is often worsened, and may be predicted by entity of baseline GH hypersecretion and by the dose of PAS-LAR. Moreover, our data, although limited by small numbers, may suggest that the combination treatment PAS-LAR + Peg-V can improve glucose homeostasis in selected patients.

Highlights

Disorders of glucose metabolism are a serious acromegaly comorbidity and may be differently impacted by medical treatments of acromegaly
Glucose homeostasis represents a relevant clinical problem in acromegaly, to which both growth hormone (GH) and IGF-I hypersecrection and medical therapies can contribute, their reciprocal role is not yet completely cLARified [2, 11,12,13,14,15, 21, 22]. Concerning the latter aspect, an increased awareness was raised by the PAS- LAR use, which was associated with higher diabetes risk [13,14,15]
We investigated the alterations of glucose metabolism in acromegaly patients before and during longterm treatment PAS- LAR alone and in combination with Peg-V

Summary

Introduction

Disorders of glucose metabolism are a serious acromegaly comorbidity and may be differently impacted by medical treatments of acromegaly In this retrospective longitudinal multicenter study, we investigated the outcome of glucose metabolism and its predictors in patients treated with Pasireotide LAR (PAS-LAR) alone or in combination with Pegvisomant (PAS-LAR + Peg-V). Glucose metabolism improved in 3 (all in PAS-LAR + Peg-V; 7.5%), worsened in 26 (65%) and remained unchanged in 11 patients (27.5%). Among patients treated with Pas-LAR alone, GH at baseline was higher in those with worsening of glucose metabolism (p = 0.04) as compared to those with stable glucose status. Conclusions Our data confirmed that glucose metabolism in patients treated with PAS-LAR is often worsened, and may be predicted by entity of baseline GH hypersecretion and by the dose of PAS-LAR.

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