Updates in adrenal steroidogenesis inhibitors for Cushing's syndrome - A practical guide
| Autor: | Elena V. Varlamov, Ashley J. Han, Maria Fleseriu |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty Hydrocortisone Pyridines Endocrinology Diabetes and Metabolism 030209 endocrinology & metabolism law.invention 03 medical and health sciences 0302 clinical medicine Endocrinology Randomized controlled trial law Etomidate Internal medicine medicine Adrenal insufficiency Cytochrome P-450 CYP11B2 Humans Enzyme Inhibitors Practice Patterns Physicians' Adverse effect Pituitary ACTH Hypersecretion Cushing Syndrome Osilodrostat Metyrapone business.industry Imidazoles medicine.disease Clinical trial 030104 developmental biology Ketoconazole Steroids business medicine.drug |
| Zdroj: | Best practiceresearch. Clinical endocrinologymetabolism. 35(1) |
| ISSN: | 1878-1594 |
| Popis: | Medical therapy is essential in the management of patients with Cushing's syndrome (CS) when curative surgery has failed, surgery is not feasible, when awaiting radiation effect, and in recurrent cases of CS. Steroidogenesis inhibitors have a rapid onset of action and are effective in reducing hypercortisolism, however, adverse effects, including adrenal insufficiency require very close patient monitoring. Osilodrostat is the only steroidogenesis inhibitor to have been assessed in prospective randomized controlled trials and approved for Cushing's disease (CD) by the US Food and Drug Administration and for CS by the European Medical Agency (EMA). Osilodrostat has been shown to be highly effective at maintaining normal urinary free cortisol in patients with CD. Drugs such as metyrapone, ketoconazole (both EMA approved), and etomidate lack prospective evaluation(s). There is, however, considerable clinical experience and retrospective data that show a very wide efficacy range in treating patients with CS. In the absence of head-to-head comparative clinical trials, therapy choice is determined by the specific clinical setting, risk of adverse events, cost, availability, and other factors. In this review practical points to help clinicians who are managing patients with CS being treated with steroidogenesis inhibitors are presented. |
| Databáze: | OpenAIRE |
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