Pasireotide-LAR in acromegaly patients treated with a combination therapy: a real-life study. Issue 10 (October 2019)

• Record Type: Journal Article
• Authors: Lasolle, Hélène; Ferriere, Amandine; Vasiljevic, Alexandre; Eimer, Sandrine; Nunes, Marie-Laure; Tabarin, Antoine
• Is Part Of: Endocrine connections. Volume 8:Issue 10(2019)
• Page Start: 1383
• Page End: 1394
• Publication Date: 2019-10
• Subjects: acromegaly -- somatostatin analogs -- pegvisomant -- cabergoline -- Pasireotide-LAR; Endocrinology -- Periodicals; 616.4005
• DOI: 10.1530/EC-19-0332
• Languages: English
• ISSNs: 2049-3614

Abstract

Abstract : Purpose: Little data are available regarding the safety and efficacy of switching to Pasireotide-LAR monotherapy in acromegaly patients with partial resistance to first-generation somatostatin agonists (1gSRL) who require combination treatment with cabergoline or pegvisomant. Method: In this monocentric prospective study within a tertiary university hospital, 15 consecutive acromegalic adults partially resistant to 1gSRL treated with octreotide LAR or lanreotide SR, and cabergoline ( n = 4, 3.5 mg/week) or pegvisomant ( n = 11, median dose 100 mg/week), were switched to Pasireotide-LAR (8 with 40 mg/month; 7 with 60 mg/month). Immunohistochemical expression level of SSTR5 and the granulation pattern of nine somatotroph adenomas were retrospectively determined to test for a correlation with the therapeutic efficacy of Pasireotide-LAR. Results: Median IGF-1 concentration at the first evaluation (median 3 months) was similar to baseline (1.0 vs 1.1 ULN). 11/15 patients had IGF-1 levels ≤1.3 ULN before and after the switch but individual changes were variable. Hyperglycemia was frequent and greater in diabetic patients. 7/15 patients stopped Pasireotide-LAR due to lack of control of IGF-1 or intolerance. 8/15 patients received Pasireotide-LAR for a median of 29 months with IGF-1 levels ≤1.3 ULN and acceptable glucose tolerance (median HbA1c 6.1%). Two patients required initiation of oral antidiabetic treatment. The intensity of SSTR5 expression and the granulation pattern of adenomas were of limited value for the prediction of Pasireotide-LAR effectiveness. Conclusion: Pasireotide-LAR may represent a suitable therapeutic alternative in a subset of acromegalic patients requiring combination therapy involving a 1gSRL