Pasireotide Long‐Acting Release Treatment for Diabetic Cats with Underlying Hypersomatotropism

Abstract

BackgroundLong‐term medical management of hypersomatotropism (HS) in cats has proved unrewarding. Pasireotide, a novel somatostatin analogue, decreases serum insulin‐like growth factor 1 (IGF‐1) and improves insulin sensitivity in cats with HS when administered as a short‐acting preparation.ObjectivesAssess once‐monthly administration of long‐acting pasireotide (pasireotide LAR) for treatment of cats with HS.AnimalsFourteen cats with HS, diagnosed based on diabetes mellitus, pituitary enlargement, and serum IGF‐1 > 1000 ng/mL.MethodsUncontrolled, prospective cohort study. Cats received pasireotide LAR (6–8 mg/kg SC) once monthly for 6 months. Fructosamine and IGF‐1 concentrations, and 12‐hour blood glucose curves (BGCs) were assessed at baseline and then monthly. Product of fructosamine concentration and insulin dose was calculated as an indicator of insulin resistance (Insulin Resistance Index). Linear mixed‐effects modeling assessed for significant change in fructosamine, IGF‐1, mean blood glucose (MBG) of BGCs, insulin dose (U/kg) and Insulin Resistance Index.ResultsEight cats completed the trial. Three cats entered diabetic remission. Median IGF‐1 (baseline: 1962 ng/mL [range 1051–2000 ng/mL]; month 6: 1253 ng/mL [524–1987 ng/mL]; P < .001) and median Insulin Resistance Index (baseline: 812 μmolU/L kg [173–3565 μmolU/L kg]; month 6: 135 μmolU/L kg [0–443 μmolU/L kg]; P = .001) decreased significantly. No significant change was found in mean fructosamine (baseline: 494 ± 127 μmol/L; month 6: 319 ± 113.3 μmol/L; P = .07) or MBG (baseline: 347.7 ± 111.0 mg/dL; month 6: 319.5 ± 113.3 mg/dL; P = .11), despite a significant decrease in median insulin dose (baseline: 1.5 [0.4–5.2] U/kg; 6 months: 0.3 [0.0–1.4] U/kg; P < .001). Adverse events included diarrhea (n = 11), hypoglycemia (n = 5), and worsening polyphagia (n = 2).Conclusions and Clinical ImportancePasireotide LAR is the first drug to show potential as a long‐term management option for cats with HS.

Pharmacological treatment with cabergoline in three cats with acromegaly

“…These results are similar to those by Gostelow et al (2017) with short-action and long-acting pasireotide injection and, apparently, are more promising than those obtained with radiotherapy (the most commonly used treatment for cats with acromegaly), where no such improvement in IGF-1 levels has been observed despite improving clinical signs with reduction of insulin requirements .…”

“…Although both surgery and radiotherapy have achieved a good outcome as treatment for AMG in cats, these turn out to be invasive methods, requiring not only anesthesia, but also specialized facilities . Both short-acting and long-acting pasireotide have been tested with good response in cats with AMG, but their high cost is a limiting factor (Gostelow et al, 2017).…”

Time spent with cats is never wasted: Lessons learned from feline acromegalic cardiomyopathy, a naturally occurring animal model of the human disease

“…Treatment decisions were based upon owner choice and clinician advice at the time of diagnosis and alterations to insulin therapy were made according to individual requirements by or under the supervision of a Board certified veterinary Internist (SN). Options for treatment were medical, using long-acting once monthly somatostatin analogue pasireotide (SOM230; Signifor™, Novartis, Basel, Switzerland) injections (8 mg/kg) [ 46 ], or surgical through trans-sphenoidal hypophysectomy [ 47 ].…”

Stereotactic radiation therapy for the treatment of functional pituitary adenomas associated with feline acromegaly

“…Medical management with pasireotide, a somatostatin receptor‐ligand, has shown efficacy with a recent publication identifying diabetic remission in 3 of 8 cats treated with long‐acting pasireotide . However, this medication is prohibitively expensive and has some intolerable adverse effects including diarrhea, hypovolemia, hypoglycemia, and worsening polyphagia . Successful treatment with transphenoidal hypophysectomy has been reported, but the surgery is technically challenging with limited availability …”