Management of Hyperglycemia in a Patient with Acromegaly Treated with Pasireotide LAR: A Case Study

Abstract

ABSTRACT: Objective: Pasireotide long-acting release (LAR) demonstrated superior efficacy versus octreotide LAR in a phase III study (C2305) in medically naive patients with acromegaly. Adverse events associated with pasireotide LAR were similar to those with octreotide LAR, except for a higher rate of hyperglycemia. The clinical outcomes and management of pasireotide-induced hyperglycemia in a patient from the C2305 study are reported here.Methods: C2305 was a prospective, double-blind study in medically naive patients randomized to receive pasireotide LAR 40 mg or octreotide LAR 20 mg every 28 days. Growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels were measured at baseline and every 3 months thereafter. Glycemic parameters were assessed based on criteria established by the American Diabetes Association.Results: The patient was a 56-year-old woman with acromegaly who had elevated GH and baseline IGF-1 levels 2-fold greater than the upper limit of normal. After 24 months of pasireotide LAR, GH levels were reduced 4-fold from baseline, and IGF-1 was reduced to levels within the reference range. The patient was diagnosed with diabetes at month 3 and initiated treatment with antidiabetic medications, including glimepiride, sitagliptin, and metformin. Glycemic parameters improved at month 12 and remained stable through month 24, except for a slight increase in glycated hemoglobin that prompted antidiabetic dose modification.Conclusion: Pasireotide LAR improved clinical parameters in a patient with persistently elevated GH and IGF-1 levels after surgery. While hyperglycemia was observed during the course of treatment, proactive management with antidiabetic medications quickly led to sustained glycemic control.Abbreviations: BID = twice daily; DPP-4 = dipeptidyl peptidase-4; FPG = fasting plasma glucose; GH = growth hormone; GLP-1 = glucagon-like peptide 1; HbA1c = glycated hemoglobin; IGF-1 = insulin-like growth factor 1; LAR = long-acting release; MRI = magnetic resonance imaging; SC = subcutaneous; SSA = somatostatin analog; sst = somatostatin receptor type