How to Position Pasireotide LAR Treatment in Acromegaly

• Published in: The journal of clinical endocrinology and metabolism 2019-06, Vol.104 (6), p.1978-1988
• Main Authors: Coopmans, Eva C, Muhammad, Ammar, van der Lely, Aart J, Janssen, Joseph A M J L, Neggers, Sebastian J C M M
• Format: Article
• Language: English
• Subjects: Acromegaly; Acromegaly - blood; Acromegaly - drug therapy; Acromegaly - etiology; Blood Glucose - analysis; Blood sugar; Blood sugar monitoring; Care and treatment; Clinical Trials, Phase II as Topic; Clinical Trials, Phase III as Topic; Consensus; Delayed-Action Preparations - administration & dosage; Delayed-Action Preparations - adverse effects; Diabetes mellitus; Dose-Response Relationship, Drug; Drug Therapy, Combination - methods; Drug Therapy, Combination - standards; Evidence-Based Medicine - methods; Evidence-Based Medicine - standards; Glucose monitoring; Growth Hormone-Secreting Pituitary Adenoma - blood; Growth Hormone-Secreting Pituitary Adenoma - complications; Growth Hormone-Secreting Pituitary Adenoma - drug therapy; Headache; Human Growth Hormone - administration & dosage; Human Growth Hormone - analogs & derivatives; Humans; Hyperglycemia; Hyperglycemia - blood; Hyperglycemia - chemically induced; Hyperglycemia - diagnosis; Hyperglycemia - drug therapy; Hypoglycemic Agents - therapeutic use; Ligands; Medical treatment; Patient Selection; Patients; Pegvisomant; Pharmaceutical industry; Practice Guidelines as Topic; Somatostatin; Somatostatin - administration & dosage; Somatostatin - adverse effects; Somatostatin - analogs & derivatives; Treatment Outcome
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2018-01979

Abstract Context Pasireotide long-acting release (LAR) is a somatostatin multireceptor ligand, and in the current consensus criteria pasireotide LAR is considered the second-line medical treatment for acromegaly. We present in this article our recommendations to define the position of pasireotide LAR in the treatment of acromegaly and provide recommendations for the management of pasireotide-induced hyperglycemia. Evidence Acquisition Our recommendations are based on our experiences with the pasireotide LAR and pegvisomant (PEGV) combination study and the available basic or clinical articles published in peer-reviewed international journals on pasireotide LAR and acromegaly. Evidence Synthesis In accordance with the current consensus criteria, we recommend pasireotide LAR monotherapy as a second-line therapy in young patients who show tumor growth during first-generation somatostatin receptor ligand (SRL) therapy and in patients who show tumor growth during PEGV therapy. In addition, we recommend pasireotide LAR monotherapy in patients with headache not responsive to first-generation SRL therapy and in patients who experience side effects or are intolerant to PEGV monotherapy. In contrast to the current consensus criteria, we recommend considering combination therapy with pasireotide LAR and PEGV as third-line treatment in patients without diabetes at low PEGV dosages (≤80 mg/week) and in patients with tumor growth or symptoms of active acromegaly during first-generation SRL and PEGV combination therapy. With respect to pasireotide-induced hyperglycemia, we recommend a more liberal strategy of blood glucose monitoring during pasireotide treatment. Conclusions In contrast to the current consensus criteria, we recommend a more reluctant use of pasireotide LAR therapy for the treatment of acromegaly. Based on our experiences with the Pasireotide LAR and Pegvisomant Study in Acromegaly and on the currently available literature, we provide recommendations to define the position of pasireotide long-acting release in the treatment of acromegaly.