Long-term pasireotide therapy in acromegaly: extensive real-life experience of a referral center.

Abstract

Pasireotide is a novel therapeutic option for patients with acromegaly resistant to first-generation somatostatin receptor ligands. To date, real-life data are still scant, therefore, the aim of the current study is to evaluate the impact of long-term pasireotide therapy on disease control, pituitary tumor size, gluco-insulinemic and lipid profile in a real-life setting. Retrospective study of data prospectively collected, evaluating hormonal, tumoral, and metabolic data of 28 patients with acromegaly administered with pasireotide in a pituitary tertiary referral center. Within the first 12months of treatment, 70.4% of patients achieved normal IGF-I levels, whichwas maintained at 36-month evaluationin these responders patients. Patients who started with pasireotide 60mg monthly exhibited significantly lower IGF-I levels after 36months (p = 0.05) as compared to patients administered first with pasireotide 20 or 40mg monthly. The maximal tumoral diameter was significantly decreased after 12months of pasireotide (p < 0.001) and a further reduction was registered throughout the following months, with 41.2% of patients achieving a significant reduction (> 25% of baseline measurement) after 36months of treatment. Fasting glucose significantly increased during the first 6months (p < 0.001) with a gradual rise in diabetes prevalence during the following months, resulting diabetes prevalence after 36months of pasireotide significantly increased compared to baseline (p = 0.003), although with glycated hemoglobin levels within the normal range. Diabetes was managed using oral glucose-lowering drugs or glucagon-like peptide 1 agonists, with no patient requiring insulin therapy. Pasireotide improved lipid profile, mainly during the first 12months of treatment, by increasing HDL and decreasing triglycerides levels. Pasireotide is effective and safe in the long-term. Hyperglycemia is a common event and is manageable even without insulin treatment.