ECE2021 Oral Communications Oral Communications 8: Pituitary and Neuroendocrinology (6 abstracts)
Osilodrostat is an effective and well-tolerated treatment option for patients with Cushing’s disease (CD): Final results from the LINC3 study
Maria Fleseriu 1 , Beverly Biller 2 , Rosario Pivonello 3 , Shimatsu Akira 4 , Scaroni Carla 5 , Zhanna Belaya 6 , Greisa Vila 7 , Ghislaine Houde 8 , Rama Walia 9 , Miguel Izquierdo 10 , Michael Roughton 10 , Alberto Pedroncelli 11 & John Newell-Price 12
1Oregon Health & Science University, Pituitary Center, Departments of Medicine and Neurological Surgery, Portland, United States; 2Massachusetts General Hospital, Neuroendocrine and Pituitary Tumor Clinical Center, Boston, United States; 3Università Federico II di Napoli, Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Naples, Italy; 4Kusatsu General Hospital, Advanced Medical Care Center, Kusatsu, Japan; 5Padova University Hospital, Endocrinology Unit, Department of Medicine, Padova, Italy; 6The National Medical Research Centre for Endocrinology, Moscow, Russian Federation; 7Medical University of Vienna, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Vienna, Austria; 8University of Sherbrooke, Department of Medicine, Division of Endocrinology, Sherbrooke, Canada; 9Postgraduate Institute of Medical Education and Research (PGIMER), Department of Endocrinology, Chandigarh, India; 10Novartis Pharma AG, Basel, Switzerland; 11Recordati AG, Basel, Switzerland; 12The Medical School, University of Sheffield, Department of Oncology and Metabolism, Sheffield, United Kingdom
Introduction
Osilodrostat, a potent oral 11β-hydroxylase inhibitor, normalized mean urinary free cortisol (mUFC) in most patients with CD during the 48-week (W) core phase of a Phase III study (LINC3: NCT02180217). We present efficacy and safety results following an extension to LINC3.
Methods
CD patients with mUFC > 1.5× upper limit of normal (ULN) received osilodrostat during the core. Patients benefiting from osilodrostat at W48 could enter an extension. Dose adjustments were permitted (maximum dose 30mg bid). LINC3 ended when all ongoing patients had received ≥72 weeks’ treatment and could enter a separate safety study (results of which are not presented here). Efficacy/safety are reported for all enrolled patients unless otherwise stated. Mean change is calculated for patients with evaluable assessments at core baseline and W72.
Results
106 of 137 enrolled patients entered the extension. Median osilodrostat exposure from core baseline to study end for all enrolled patients was 130 weeks (range, 7–245), with a median dose of 7.4mg/day. 98 patients completed W72 and 52 received 33 years of treatment. At W72, 81% (86/106) of patients who entered the extension had mUFC ≤ ULN. Mean mUFC and serum and late-night salivary cortisol levels remained ≤ULN during the extension. Improvements in cardiovascular-related parameters were maintained during the extension; mean (SD) change from core baseline to W72: systolic BP, –10.1 (18.1) mmHg; diastolic BP, –5.8 (11.3) mmHg; HbA1c, –0.4% (0.6); BMI, –1.8 (2.5) kg/m2. AEs related to hypocortisolism and adrenal hormone precursor accumulation, respectively, occurred in 54% (74/137) and 58% (80/137) of patients during the study. Most hypocortisolism-related AEs emerged during the first 26 weeks of treatment. AEs related to adrenal hormone precursor accumulation were less frequent in the extension than the core (occurring in 46%, 19%, 15% and 15% of patients with a safety assessment during the following intervals: baseline‒W26, W26‒48, W48‒72 and W72‒study end). Overall, 32% (34/106) of patients who entered the extension discontinued, most commonly because of AEs or patient/guardian decision (n = 12 each). Median change in tumour volume from core baseline to W72 was 1.0 mm3 (range: ‒74.7 to 1268.5). Mean (SD) 11-deoxycortisol level was stable during the extension (7.4 [6.7] ×ULN at W72). Mean (SD) testosterone level tended to decrease in females during the extension (0.8 [0.7] ×ULN at W72).
Conclusions
Osilodrostat provided long-term control of mUFC in CD patients and improved clinical signs of hypercortisolism and QoL. Osilodrostat was well tolerated, with no new safety signals reported during long-term treatment.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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