Abstract
ContextPasireotide-LAR, a second-generation somatostatin receptor ligand (SRL), is recommended for patients with acromegaly as second-line treatment. Its efficacy and safety were assessed in clinical trials; however, the real-world evidence is still scarce.ObjectiveThe aim of this study was to evaluate the impact of 1-year treatment with pasireotide-LAR on disease control and glucose metabolism in acromegaly patients resistant to first-generation SRLs.DesignA single-center prospective study.MethodsTwenty-eight patients with active acromegaly or acrogigantism on first-generation SRLs following ineffective pituitary surgery were switched to treatment with pasireotide-LAR 40 or 60 mg i.m. every 28 days. To assess the efficacy of the treatment GH and IGF-1 levels were measured every 3 months. Safety of treatment was carefully evaluated, especially its impact on glucose metabolism.ResultsComplete biochemical control (GH ≤ 1 ng/mL and IGF-1 ≤ 1 × ULN) was achieved in 26.9% of patients and partial + complete response (GH ≤ 2.5 ng/mL and IGF-1 ≤ 1.3 × ULN) in 50.0% of patients. Mean GH level decrease was the largest within first 6 months (P = 0.0001) and mean IGF-1 level decreased rapidly within the first 3 months (P < 0.0001) and they remained reduced during the study. Blood glucose and HbA1c levels increased significantly within 3 months (P = 0.0001) and stayed on stable level thereafter. Otherwise, the treatment was well tolerated and clinical improvement was noticed in majority of patients.ConclusionsThis real-life study confirmed good effectiveness of pasireotide-LAR in patients resistant to first-generation SRLs. Pasireotide-LAR was overall safe and well tolerated, however significant glucose metabolism worsening was noted.
Highlights
Growth hormone (GH)-secreting pituitary adenoma is a leading cause of acromegaly and pituitary gigantism
The GH hypersecretion results in overproduction of insulin-like growth factor 1 (IGF-1), which contributes to somatic overgrowth, distorted body proportion and systemic manifestations, such as upper airways obstruction, cardiovascular complications, and metabolic disorders [1,2,3]
The aim of this study was to evaluate the impact of 1-year treatment with pasireotide-LAR on biochemical disease control and on glucose metabolism in patients with acromegaly resistant to first-generation somatostatin receptor ligand (SRL) in clinical practice
Summary
Growth hormone (GH)-secreting pituitary adenoma is a leading cause of acromegaly and pituitary gigantism. The GH hypersecretion results in overproduction of insulin-like growth factor 1 (IGF-1), which contributes to somatic overgrowth, distorted body proportion (mainly involving the face and extremities) and systemic manifestations, such as upper airways obstruction, cardiovascular complications, and metabolic disorders [1,2,3]. The most frequent (up to 50% of patients) metabolic disorders in acromegaly resulting from. Treatment of acromegaly is aimed at excising the diseasecausing lesion and reducing GH and IGF-1 levels to normal values. Achieving a disease control results in normal-life expectancy and improvement in comorbidities. Transsphenoidal selective adenomectomy is considered to be a first-line treatment with reported biochemical cure rates varying between 32 and 85% depending on neurosurgeon experience, tumor size and cavernous sinus invasion. In patients with non-radical surgery, in whom re-operation is
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