ECE2020 Audio ePoster Presentations Pituitary and Neuroendocrinology (217 abstracts)
Pasireotide-induced hyperglycemia and efficacy of antidiabetic treatments in patients with acromegaly: Evaluation of two referral centers
Ludovica F.S. Grasso 1 , Sabrina Chiloiro 2 , Rosa Pirchio 1 , Antonella Giampietro 2 , Renata S. Auriemma 1 , Antonio Bianchi 2 , Maria Cristina De Martino 1 , Mariarosaria Negri 1 , Annamaria Colao 1 , Alfredo Pontecorvi 2 , Laura De Marinis 2 & Rosario Pivonello 1
1University Federico II of Naples, Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Naples, Italy; 2Fondazione Universitaria A. Gemelli, IRCCS, Unità Operativa di Patologia Ipofisaria, Dipartimento di Endocrinologia e Diabetologia, Area Endocrino-Metabolica e Dermo-reumatologica, Rome, Italy
Pasireotide (PAS) has a safety profile similar to first-generationsomatostatin analogues (SSA), except for a higher frequency of hyperglycaemia-related adverse events (AEs). However, consensus on the best management of PAS-induced hyperglycaemia in acromegalic patients has still to be defined. The current study aims at investigating the effects of long-term PAS treatment on glucose metabolism, by evaluating the clinical management of hyperglycemia-relatedAEs in acromegalic patients followed in two Italian referral centers, participating to the PAOLA study. The role of metabolic parameters (weight, BMI, fasting glucose and HbA1c levels) and markers of disease activity (GH, IGF-I, duration of PAS treatment) were investigated as potential predictors of hyperglycemia development. A total of 31 patients (16 F/15 M, mean age 47.6 years) entered the study. Patients were treated with PAS for a mean time of 34 months (6–67). Glycemic control was established with HbA1c at 7%. During PAS treatment, mean FPG and HbA1c concentrations significantly increased (P = 0.005) after 6 months of treatment, remaining persistently elevated until the last follow-up (P = 0.005). At baseline, pre-existing diabetes mellitus (DM) was found in 6 (19%), and glucose intolerance (GI) in 4 (13%) patients. Hyperglycemia-related AEs, generally mild to moderate, were reported in 24 patients (77.4%, 5 worsening DM, 9 DM, 9 GI), occurring after a mean time of 6 months (1–17 months).One patient discontinued because of DM. At regression analysis, baseline glucose levels resulted aspotential predictors of hyperglycemia during PAS therapy (P = 0.04, r = 0.25). At study entry, 4 patients (13%) were already treated with antidiabetic drugs. Eight patients (33.3%) were treated only with hypocaloric diet for the study duration. Starting of new antidiabetic treatment was required in 12 patients (50%) throughout the study, and metformin (MET) was as first-line therapyfor all patients. Seven (58.3%) patients did not control glucose and HbA1c levels despite MET monotherapy, needing further therapies. MET was associated with DPP-4 inhibitor in 2 patients (16.6%), GLP-1 agonist in 3 patients (25%), GLP-1 agonist and glargine insulin in 2 patients (16.6%) patient to control hyperglycemia. Five patients (20.8%), 1 patient treated with MET (20%), 1 with hypocaloric diet (20%), 1 with MET and glargine insulin (20%) and 2 with insulin (40%)were uncontrolled at last follow-up. In conclusion, the results of the current study show a long-term effect of PAS therapy on glucose metabolism, but treatment with MET or its association with incretin resulted in good glycemic control in most patients.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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