title: Hyperglycemia induced by pasireotide in patients with Cushing's disease or acromegaly.
abstract: OBJECTIVE
  Cushing's disease (CD) and acromegaly are characterized by excessive hormone secretion resulting in comorbidities such as impaired glucose metabolism, diabetes and hypertension. Pasireotide is a new-generation, multireceptor-targeted somatostatin receptor ligand approved for CD (subcutaneous [SC] injection formulation) and acromegaly (long-acting release [LAR] formulation). In clinical studies of pasireotide, hyperglycemia-related adverse events (AEs) were frequently observed. This review highlights differences in reported rates of hyperglycemia in pasireotide trials and discusses risk factors for and management of pasireotide-associated hyperglycemia.
  
  
  METHODS
  Clinical trials evaluating pasireotide in patients with CD or acromegaly were reviewed.
  
  
  RESULTS
  The frequency of hyperglycemia-related AEs was lower in patients with acromegaly treated with pasireotide LAR (57.3-67.0 %) than in patients with CD treated with pasireotide SC (68.4-73.0 %). Fewer patients with acromegaly treated with pasireotide LAR discontinued therapy because of hyperglycemia-related AEs (Colao et al. in J Clin Endocrinol Metab 99(3):791-799, 2014, 3.4 %; Gadelha et al. in Lancet Diabetes Endocrinol 2(11):875-884, 2014, 4.0 %) than did patients with CD treated with pasireotide SC (Boscaro et al. in Pituitary 17(4):320-326, 2014, 5.3 %; Colao et al. in N Engl J Med 366(10):914-924, 2012, 6.0 %). Hyperglycemia-related AEs occurred in 40.0 % of patients with acromegaly treated with pasireotide SC, and 10.0 % discontinued treatment because of hyperglycemia. Ongoing studies evaluating pasireotide LAR in patients with CD and management of pasireotide-induced hyperglycemia in patients with CD or acromegaly (ClinicalTrials.gov identifiers NCT01374906 and NCT02060383, respectively) will address these key safety issues.
  
  
  CONCLUSIONS
  Disease pathophysiology, drug formulation, and physician experience potentially influence the differences in reported rates of pasireotide-induced hyperglycemia in CD and acromegaly. Hyperglycemic effects associated with pasireotide have a predictable pattern, can be managed with antidiabetic agents, and are reversible upon discontinuation.
authors.affiliation: Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St Louis, MO, USA. jsilvers@dom.wustl.edu.
authors.forename: Julie M
authors.identifier: http://orcid.org/0000-0002-2437-1346
authors.initials: JM
authors.lastname: Silverstein
mesh_terms: D000172:Acromegaly / Q000188:drug therapy*; D006728:Hormones / Q000009:adverse effects*; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced* / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D047748:Pituitary ACTH Hypersecretion / Q000188:drug therapy*; D013004:Somatostatin / Q000009:adverse effects / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D006728:Hormones; D007004:Hypoglycemic Agents; D013004:Somatostatin; C517782:pasireotide
keywords: Acromegaly; Cushing’s disease; Hyperglycemia; Pasireotide