Efficacy and side effects of subcutaneous pasireotide alone or in combination with cabergoline in patients with cushing

Alev Selek; Nurgul Demir; Berrin Cetinarslan; Zeynep Canturk; Emre Gezer; Mehmet Sozen; Damla Koksalan; Ozlem Alkan; Saadet Acar; Fatma Oktem

doi:10.1530/endoabs.99.EP1304

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Endocrine Abstracts (2024) 99 EP1304 | DOI: 10.1530/endoabs.99.EP1304

ECE2024 Eposter Presentations Late Breaking (127 abstracts)

Efficacy and side effects of subcutaneous pasireotide alone or in combination with cabergoline in patients with cushing’s disease whithout postoperative remission

Alev Selek , Nurgül Demir , Berrin Çetinarslan , Zeynep Cantürk , Emre Gezer , Mehmet Sözen , Damla Köksalan , Özlem Alkan , Saadet Acar & Fatma Öktem

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kocaeli university, endocrinology, Kocaeli

Pasireotide is a second-generation, multireceptor-targeted somatostatin receptor ligand and is approved for the treatment of patients with Cushing’s Didease (CD) for whom surgery has failed or is not an option. This retrospective single center study aims to report the efficacy, side effects and follow-up of the treatment with pasireotide alone or in combination with cabergoline in patients without remission after transsphenoidal surgery. Among 187 patients with CD, 15 patients, who did not achieve post operative remission and on pasireotide tretment, were enrolled to the study. Demographic data, comorbid diseases and clinical status of the patients before pasireotide treatment were shown on table 1. The mean pasireotide treatment duration was 15±13 months. UFC normalization was seen in 10 (67%) patients in 12 months, 2 patients discontinue the treatment <6 months because of drug intolerance (gastrointestinal disturbance and hypoglycemia) and 3 patients were unresponsive. Among 10 patients with normalization of UFC, 3 had remission and stopped medication after three years (2 had radiosurgery before, one not), one patient had treatment escape after 3 years and 6 of them are still on medication. New onset diabetes was seen in two cases (13%) however deterioration of glycemic control was seen in 3 (50%) of the diabetic patients. Cholelithiasis was seen in one patient. Clinical prognostic factors were also evaluated between pasireotide responsive and nonresponsive groups; all the factors were similar between groups probably due to small sample size (table 2). Pasireotide is an effective treatment in patients without surgical remission. Approximately half of the patients in our study were successfully treated with pasireotide alone or in combination with cabergoline without severe side effects. Radiosurgery is another treatment choice and pasireotide is also a good option until the effect of radiosurgery appears.

Table 1.
12 female (80%)	Mean age was 43±15 years
9 macroadenoma (60%)	Mean follow-up was 80±58 months
6 overt diabetes mellitus (40%) 5 prediabetes (33%)	Mean tumor size was 14.6±11.8 mm
6 2 or more operations (40%)	Mean pretreatment kortizol was 17.6±5.8 mg/dl
10 sterotactic radiosurgery (67%)	Mean pretreatment ACTH was 63.9±43 pg/ml
12 on cabergoline treatment (80%)	Mean pretreatment fold increase of urinary-free cortisol (UFC)was 2.7±1 /day (x ULN)

Table 2.
mean (±STD)	Pasireotide Responsive 10 (67%)	Pasireotide Unresponsive 5 (33%)
Age, years	14, 5±3	14, 8±7, 6
Tumor size, mm	45, 5±5.2	39.2±6
Pretreatment kortizol, mg/dl	16±14	20±10.3
Pretreatment ACTH, pg/ml	60±46	70±31
Pretreatment UFC, fold increase	2.2	3