Pasireotide-Induced Hyperglycemia

Kumar, Nitya K

doi:10.15406/mojcr.2017.06.00155

Cited by 2 publications

(3 citation statements)

References 7 publications

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“…By binding these SSTRs, pasireotide reduces secretion of GH and ACTH in patients with acromegaly or Cushing's disease [14][15][16]. However, this unique binding profile can also increase blood glucose levels in some patients [7][8][9][10], resulting from inhibition of insulin secretion and the incretin response and only modest suppression of glucagon [17,18], which is reversible upon discontinuation of pasireotide [19]. Nevertheless, pasireotide did not appear to affect insulin sensitivity [17].…”

Section: Introductionmentioning

confidence: 99%

Managing pasireotide-associated hyperglycemia: a randomized, open-label, Phase IV study

Samson

Feldt‐Rasmussen

et al. 2021

Pituitary

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Purpose Pasireotide is an effective treatment for acromegaly and Cushing’s disease, although treatment-emergent hyperglycemia can occur. The objective of this study was to assess incretin-based therapy versus insulin for managing pasireotide-associated hyperglycemia uncontrolled by metformin/other permitted oral antidiabetic drugs. Methods Multicenter, randomized, open-label, Phase IV study comprising a core phase (≤ 16-week pre-randomization period followed by 16-week randomized treatment period) and optional extension (ClinicalTrials.gov ID: NCT02060383). Adults with acromegaly (n = 190) or Cushing’s disease (n = 59) received long-acting (starting 40 mg IM/28 days) or subcutaneous pasireotide (starting 600 µg bid), respectively. Patients with increased fasting plasma glucose (≥ 126 mg/dL on three consecutive days) during the 16-week pre-randomization period despite metformin/other oral antidiabetic drugs were randomized 1:1 to open-label incretin-based therapy (sitagliptin followed by liraglutide) or insulin for another 16 weeks. The primary objective was to evaluate the difference in mean change in HbA1c from randomization to end of core phase between incretin-based therapy and insulin treatment arms. Results Eighty-one (32.5%) patients were randomized to incretin-based therapy (n = 38 received sitagliptin, n = 28 subsequently switched to liraglutide; n = 12 received insulin as rescue therapy) or insulin (n = 43). Adjusted mean change in HbA1c between treatment arms was – 0.28% (95% CI – 0.63, 0.08) in favor of incretin-based therapy. The most common AE other than hyperglycemia was diarrhea (incretin-based therapy, 28.9%; insulin, 30.2%). Forty-six (18.5%) patients were managed on metformin (n = 43)/other OAD (n = 3), 103 (41.4%) patients did not require any oral antidiabetic drugs and 19 patients (7.6%) were receiving insulin at baseline and were not randomized. Conclusion Many patients receiving pasireotide do not develop hyperglycemia requiring oral antidiabetic drugs. Metformin is an effective initial treatment, followed by incretin-based therapy if needed. ClinicalTrials.gov ID: NCT02060383.

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Section: Introductionmentioning

confidence: 99%

Managing pasireotide-associated hyperglycemia: a randomized, open-label, Phase IV study

Samson

Feldt‐Rasmussen

et al. 2021

Pituitary

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“…Pasireotid je novším preparátom SSA, ktorý môže u niektorých pacientov nereagujúcich na oktreotid a lanreotid docieliť dostatočnú biochemickú kontrolu ochorenia (5). V dôsledku inhibície sekrécie inzulínu, inhibície inkretínovej odpovede a len miernej supresie glukagónu pri liečbe pasireotidom je nežiaducim účinkom liečby hyperglykémia (6). Hyperglykémia je reverzibilná a pri prerušení liečby dochádza k jej úprave (6).…”

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“…V dôsledku inhibície sekrécie inzulínu, inhibície inkretínovej odpovede a len miernej supresie glukagónu pri liečbe pasireotidom je nežiaducim účinkom liečby hyperglykémia (6). Hyperglykémia je reverzibilná a pri prerušení liečby dochádza k jej úprave (6). Agonisty dopamínu (kaberogolín) majú iba obmedzenú účinnosť a často sa používajú ako adjuvantná terapia (5).…”

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Pegvisomant in the treatment of acromegaly

Ságová¹,

Mokáň²,

Payer³

et al. 2022

Vnitř Lék

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Národný endokrinologický a diabetologický ústav Ľubochňa 2 1. interná klinika UN a JLFUK Martin 3 V. interná klinika LFUK a UN Bratislava Napriek zlepšeniu chirurgických techník, súčasným možnostiam rádioterapie aj vývoju dlhodobo pôsobiacich analógov somatostatínu sa u niektorých pacientov s akromegáliou nepodarí docieliť biochemickú kontrolu ochorenia. Nedosiahnutie optimálnych sérových hodnôt rastového hormónu (RH) a inzulínu podobného rastového faktora-1 (IGF-1) je spojené so zvýšenou morbiditou a mortalitou pacientov s akromegáliou. Antagonista receptora pre RH pegvisomant (PEG) je geneticky upravený analóg RH, ktorý zabraňuje dimerizácii receptora pre RH, t. j. procesu, ktorý je rozhodujúci pre pôsobenie RH na bunkovej úrovni. Efektom liečby je potlačenie produkcie IGF-1. V pilotných štúdiách bola dosiahnutá normalizácia hladín IGF-1 až v 90 % pacientov užívajúcich PEG. Účinnosť PEG v klinickom prostredí je o niečo nižšia, ako sa uvádza v kľúčových štúdiách, napriek tomu PEG normalizuje hladiny IGF-1 v rozsahu 65 až 97 % prípadov. Zriedkavým nežiaducim účinkom liečby môže byť zvýšenie pečeňových transamináz. Okrem toho bola v niekoľkých prípadoch opísaná progresia rastu tumoru hypofýzy. V našom prehľadovom článku uvádzame dlhodobé údaje týkajúce sa liečby pegvisomantom, diskutujeme o súvisiacich rizikách a prínosoch liečby.Kľúčové slová: akromegália, inzulínu podobný rastový faktor 1, pegvisomant, rastový hormón.

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Pasireotide-Induced Hyperglycemia

Abstract: Pasireotide has been shown to be an efficacious therapeutic agent for patients with acromegaly. Its use has also been associated with hyperglycemia. We report a case of pasireotide-induced hyperglycemia and review the recommendations for combatting this side effect.

Cited by 2 publications

References 7 publications

Managing pasireotide-associated hyperglycemia: a randomized, open-label, Phase IV study

Managing pasireotide-associated hyperglycemia: a randomized, open-label, Phase IV study

Pegvisomant in the treatment of acromegaly

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