De-escalation treatment with pasireotide for acromegaly: a long-term experience.
Endocrine
; 80(3): 505-510, 2023 06.
Article
em En
| MEDLINE
| ID: mdl-36808072
ABSTRACT
INTRODUCTION:
Pasireotide long-acting release (LAR) is approved for second-line treatment of acromegaly. Starting pasireotide LAR 40 mg every 4 weeks is recommended and then up-titrate to 60 mg monthly in case of IGF-I uncontrolled levels. We present three patients treated with a de-escalation approach with pasireotide LAR. CASE 1 A 61-year-old female diagnosed with resistant acromegaly was treated with pasireotide LAR 60 mg every 28 days. When IGF-I reached the lower age range, therapy was decreased to pasireotide LAR 40 mg and then to 20 mg. In 2021 and 2022, IGF-I value remained within the normal range. CASE 2 A 40-year-old female diagnosed with resistant acromegaly underwent three neurosurgeries. In 2011, she was enrolled in the PAOLA study and assigned to pasireotide LAR 60 mg. Due to IGF-I overcontrol and radiological stability, therapy was downscaled to 40 mg in 2016 and to 20 mg in 2019. The patient developed hyperglycemia, which was treated with metformin. CASE 3 A 37-year-old male diagnosed with resistant acromegaly was treated with pasireotide LAR 60 mg in 2011. In 2018, therapy was decreased to 40 mg due to IGF-I overcontrol and in 2022 to 20 mg. He developed hyperglycemia, but HbA1c values remained under 48 nmol/L for 7 years.CONCLUSION:
De-escalation treatment with pasireotide LAR may allow a greater proportion of patients to achieve control of acromegaly, particularly in selected cases of clinically aggressive acromegaly potentially responsive to pasireotide (high IGF-I values, invasion of the cavernous sinuses, partial resistance to first-line somatostatin analogues and positive expression of somatostatin receptor 5). Another benefit may be IGF-I oversuppression overtime. The major risk seems to be hyperglycemia.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Acromegalia
/
Hiperglicemia
Limite:
Adult
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Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Endocrine
Assunto da revista:
ENDOCRINOLOGIA
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Itália