Pasireotide-LAR in acromegaly patients treated with a combination therapy: a real-life study
| Autor: | Amandine Ferriere, Hélène Lasolle, Antoine Tabarin, Marie-Laure Nunes, Alexandre Vasiljevic, Sandrine Eimer |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Combination therapy Endocrinology Diabetes and Metabolism 030209 endocrinology & metabolism lcsh:Diseases of the endocrine glands. Clinical endocrinology Gastroenterology 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Endocrinology Pasireotide-LAR Cabergoline Internal medicine Acromegaly Internal Medicine medicine Prospective cohort study pegvisomant lcsh:RC648-665 business.industry Research medicine.disease Pasireotide somatostatin analogs Somatostatin chemistry 030220 oncology & carcinogenesis Pegvisomant acromegaly cabergoline business Life study medicine.drug |
| Zdroj: | Endocrine Connections Endocrine Connections, Vol 8, Iss 10, Pp 1383-1394 (2019) |
| ISSN: | 2049-3614 |
| Popis: | 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 |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|