How to Position Pasireotide LAR Treatment in Acromegaly

Eva C. Coopmans; Ammar Muhammad; Aart J. van der Lely; Joseph A. M. J. L. Janssen; Sebastian J. C. M. M. Neggers

Disclosures

J Clin Endocrinol Metab. 2019;104(6):1978-1988. 

In This Article

Conclusions

Our recommendations are based on individual characteristics of patients with active acromegaly and may help clinicians decide when to start pasireotide LAR. In accordance with the current consensus criteria, we recommend pasireotide LAR monotherapy as a second-line therapy for young patients who show tumor growth during first-generation SRL therapy and for patients who show tumor growth during PEGV therapy. In addition, we recommend pasireotide LAR monotherapy as a second-line therapy for patients with headache not responsive to first-generation SRL therapy and for patients who experience side effects or cannot tolerate PEGV monotherapy. We recommend considering combination therapy with pasireotide LAR and PEGV as a third-line treatment option in patients with tumor growth or symptoms of active acromegaly during first-generation SRL and PEGV combination therapy. Combination therapy with pasireotide LAR and PEGV may also be considered as third-line therapy for patients without diabetes, using low PEGV dosages (≤80 mg/wk) during combination therapy with first-generation SRLs.

We provide practical tools for endocrinologists to manage pasireotide-induced hyperglycemia. We recommend a more liberal strategy of blood glucose monitoring, because hyperglycemia is usually manageable with proactive monitoring and prompt intervention. The real challenge in daily practice for every endocrinologist is to decide for each patient with acromegaly whether the potential advantages of pasireotide LAR treatment outweigh the potential disadvantages of such treatment.

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