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

Susan L Samson1,2, Feng Gu3, Ulla Feldt-Rasmussen4

  • 1Baylor College of Medicine, Houston, TX, USA. samson.susan@mayo.edu.

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|July 18, 2021
PubMed
Summary
This summary is machine-generated.

Incretin-based therapy showed a slight advantage over insulin for managing hyperglycemia in patients treated with pasireotide. Metformin is an effective initial treatment for pasireotide-associated hyperglycemia.

Keywords:
AcromegalyCushing’sHyperglycemiaIncretin-based therapyInsulinPasireotide

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Area of Science:

  • Endocrinology
  • Pharmacology
  • Clinical Trials

Background:

  • Pasireotide effectively treats acromegaly and Cushing's disease.
  • Hyperglycemia is a common side effect of pasireotide treatment.
  • Management of pasireotide-induced hyperglycemia requires careful consideration.

Purpose of the Study:

  • To compare incretin-based therapy with insulin for managing hyperglycemia in patients treated with pasireotide.
  • To evaluate the efficacy of sitagliptin and liraglutide versus insulin in patients uncontrolled by metformin or other oral antidiabetic drugs.

Main Methods:

  • A multicenter, randomized, open-label, Phase IV study (NCT02060383) was conducted.
  • Adult patients with acromegaly or Cushing's disease receiving pasireotide were included.
  • Patients with uncontrolled hyperglycemia despite oral antidiabetic drugs were randomized to incretin-based therapy or insulin for 16 weeks.

Main Results:

  • Incretin-based therapy resulted in a mean HbA1c reduction of -0.28% compared to insulin.
  • Diarrhea was the most frequent adverse event, occurring in 28.9% of the incretin-based therapy group and 30.2% of the insulin group.
  • Many patients (41.4%) did not require oral antidiabetic drugs for hyperglycemia management.

Conclusions:

  • Pasireotide treatment does not always lead to hyperglycemia requiring oral antidiabetic drugs.
  • Metformin is an effective first-line treatment for pasireotide-associated hyperglycemia.
  • Incretin-based therapy can be a viable option for patients requiring additional treatment.