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Multicenter Study
. 2021 Sep;73(3):658-666.
doi: 10.1007/s12020-021-02711-3. Epub 2021 Apr 27.

Glucose metabolism outcomes in acromegaly patients on treatment with pasireotide-LAR or pasireotide-LAR plus Pegvisomant

Sabrina Chiloiro  1   2 , Antonella Giampietro  1   2 , Felicia Visconti  1   2 , Laura Rossi  1   2 , Federico Donfrancesco  1   2 , Cara M Fleseriu  3   4 , Federica Mirra  1   2 , Alfredo Pontecorvi  1   2 , Andrea Giustina  5 , Maria Fleseriu #  3 , Laura De Marinis #  6   7 , Antonio Bianchi  1   2
Affiliations
Multicenter Study

Glucose metabolism outcomes in acromegaly patients on treatment with pasireotide-LAR or pasireotide-LAR plus Pegvisomant

Sabrina Chiloiro et al. Endocrine. 2021 Sep.

Abstract

Introduction: Disorders of glucose metabolism are a serious acromegaly comorbidity and may be differently impacted by medical treatments of acromegaly. In this retrospective longitudinal multicenter study, we investigated the outcome of glucose metabolism and its predictors in patients treated with Pasireotide LAR (PAS-LAR) alone or in combination with Pegvisomant (PAS-LAR + Peg-V).

Subjects and methods: Acromegaly patients treated continously with PAS-LAR or PAS-LAR + Peg-V for at least 6 months.

Results: Forty patients (25 females, 15 males) were enrolled. At last visit, 27/40 patients (67.5%) reached biochemical control of acromegaly. Overall, glucose metabolism improved in 3 (all in PAS-LAR + Peg-V; 7.5%), worsened in 26 (65%) and remained unchanged in 11 patients (27.5%). Glucose metabolism worsened in 25 patients (73.5%) treated with PAS-LAR and in a single patient (16.7%) treated with PAS-LAR + Peg-V (p < 0.001). Among patients treated with Pas-LAR alone, GH at baseline was higher in those with worsening of glucose metabolism (p = 0.04) as compared to those with stable glucose status. A significantly higher reduction of HbA1c was observed in patients treated with PAS-LAR + Peg-V, as compared with those treated with PAS-LAR alone (p = 0.005).

Conclusions: Our data confirmed that glucose metabolism in patients treated with PAS-LAR is often worsened, and may be predicted by entity of baseline GH hypersecretion and by the dose of PAS-LAR. Moreover, our data, although limited by small numbers, may suggest that the combination treatment PAS-LAR + Peg-V can improve glucose homeostasis in selected patients.

Keywords: Diabetes; Glucose intolerance; Growth hormone receptor antagonist; Impaired fasting glucose; Impaired glucose tolerance; Somatostatin analogues.

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Conflict of interest statement

MF reports serving as an investigator with research grants to OHSU for Crinetics, Chiasma, Ionis, Novartis, Recordati; and serving as an occasional consultant to Crinetics, Chiasma, Ipsen, Novartis, Pfizer, Recordati. ORCID: 0000-0001-9284-6289, AG: Research Grants from Ipsen, Novartis and Pfizer. Consultant for Genevant and Ipsen. The other authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
Factors associated with glucose metabolism outcome in patients on treatment with Pasireotide LAR. Box plots. Univariate analysis
Fig. 2
Fig. 2
Glucose outcome according to acromegaly treatments. Histogram. Univariate analysis
Fig. 3
Fig. 3
Glicometabolic control at the end of the study according to treatments. Box plot. Univariate analysis
Fig. 4
Fig. 4
Trend of HbA1c and IGF-I during treatment with Pasireotide LAR as monotherapy and in combination with Peg-V
See this image and copyright information in PMC

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