Pasireotide-LAR in acromegaly patients treated with a combination therapy: a real-life study

Abstract

Purpose: Little data are available regarding the safety and efficacy of s witching 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 univer sity hospital, 15 consecutive acromegalic adults partially resistant to 1gSRL tre ated 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/mo nth; 7 with 60 mg/month). Immunohistochemical expression level of SSTR5 and the granulation pattern of nine somatotroph adenomas were retrospectively deter mined to test for a correlation with the therapeutic efficacy of Pasireotide-LAR. Results: Median IGF-1 concentration at the first evaluation (median 3 mo nths) 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. Hype rglycemia was frequent and greater in diabetic patients. 7/15 patients stopped Pasireo tide-LAR due to lack of control of IGF-1 or intolerance. 8/15 patients received Pasireo tide-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 tr eatment. The intensity of SSTR5 expression and the granulation pattern of adenomas were o f 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

Keywords

• acromegaly
• somatostatin analogs
• pegvisomant
• cabergoline
• Pasireotide-LAR