Pasireotide treatment in Cushing's disease: A single tertiary center's experience

Authors: SERDAR ŞAHİN, GULAR KARİMOVA, ŞEYDA GÜL ÖZCAN, EMRE DURCAN, HANDE MEFKURE ÖZKAYA, PINAR KADIOĞLU

Abstract: Background/aim: Cushing's disease (CD), which cannot be controlled by surgery, requires medical treatment. In this situation, treatments with long-term effectiveness and safety profiles are needed. We aimed to evaluate the effects and adverse effects of pasireotide treatment in CD. Materials and methods: Patients who were followed up for CD and treated with pasireotide between 2014-2020 at Cerrahpaşa Medical Faculty, were evaluated retrospectively. The efficacy and adverse effects of pasireotide were evaluated in this study. Results: Thirty-two patients were evaluated. The mean duration of treatment was 26.5 [range, 12.0-37.0] months. The 24-h urinary free cortisol (UFC) decreased 46% during the treatment and normalized in 37.5% of patients. A significant decrement was found between pretreatment and last follow-up UFC (p = 0.001). Plasma ACTH decreased by 21%. A significant decrement was found between pre-treatment and the 3rd month, 6th month, and last follow-up ACTH levels (p = 0.014, p = 0.017, and p = 0.017, respectively). Serum cortisol levels decreased by 18% and a significant decrement was found between pretreatment and the 3rd month, and between pretreatment and the last follow-up (p = 0.034 and p = 0.013, respectively). While fasting blood glucose at the 3rd month was significantly higher than pretreatment fasting blood glucose, no significant difference was found between pretreatment fasting blood glucose and 6th month and last follow-up fasting blood glucose. Although there was a significant difference between pretreatment HbA1c levels and the HbA1c levels at the 3rd month (5.9% vs. 6.6% p = 0.007), 6th month (5.9% vs. 6.7% p = 0.003), and the last follow-up (5.9% vs. 7.1% p = 0.001), in the last follow-up, the majority (77%) of patients had adequate glycemic control (HbA1c ≤ 7.0 %). Conclusion: Pasireotide treatment is an alternative treatment in CD, remission is obtained in the first months of treatment, and continues for an extended period. Although hyperglycemia is the most common adverse effect, it can be successfully controlled.

Keywords: Cushing's disease, pasireotide treatment, hyperglycemia, hypercortisolism, UFC

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