ECE2021 Oral Communications Oral Communications 3: Pituitary and Neuroendocrinology (6 abstracts)
Metyrapone treatment in endogenous Cushing’s syndrome. Long term efficacy and safety results of the extension of the phase III/IV study PROMPT
Lynnette Nieman 1 , Marco Boscaro 2 , Scaroni Carla 3 , Timo Deutschbein 4 , Emese Mezosi 5 , Natacha Driessens 6 , Carmen Emanuela Georgescu 7 , Alicja Hubalewska-Dydejczyk 8 , Dilek Berker 9 , Barbara Jarzab 10 , Dominique Maiter 11 , Martin Reincke 12 , Paola Loli 13 , Benedetta Zampetti 13 , Ayşegül Atmaca 14 , Corin Badiu 15 , Albert Beckers 16 , Marek Bolanowski 17 , Francesco Cavagnini 18 , Nicole Unger 19 , Roberta Giordano 20 , Felicia Hanzu 21 , Massimo Terzolo 22 , Martine Bostnavaron 23 , Judit Tőke 24 & Miklos Toth 24
1National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States; 2University Hospital, Padova, Endocrinology Department, Padova, Italy; 3University Hospital, Padova, Endocrinology Department, Padova, Italy; 4University Hospital Würzburg, Dept. of Medicine I, Würzburg, Germany; 5University Medical School, Department of Internal Medicine, Pecs, Hungary; 6CUB Hôpital Erasme, Université libre de Belgique, Brussels, Belgium; 7Cluj County Emergency Hospital, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Endocrinology department, Cluj-Napoca, Romania; 8, Jagiellonian University, Medical College, Chair and Department of Endocrinology, Krakow, Poland; 9Ankara Numune Training and Research Hospital, Endocrinology Department, Ankara, Turkey; 10 im. Marii Institution, Endocrinology department, , Gliwice, Poland; 11University Hospital Saint Luc, , Endocrinology department, Brussels, Belgium; 12University Clinic, Endocrinology Department, Münich, Germany; 13Niguarda Hospital, Endocrinology Department, Milan, Italy; 14Ondokuz Mayıs University Medical Faculty, Department of Endocrinology and Metabolic Diseases, Atakum, Turkey; 15Endocrinology National Institute ’C.I Parhon’, Endocrinology deprtment, Bucharest, Romania; 16University Hospital, Liège, Belgium; 17Medical University Wroclaw, Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw, Poland; 18 Hospital San Luca, Endocrinology Department, Milan, Italy; 19University Hospital Essen, Department of Endocrinology and Metabolism, , Essen, Germany; 20University of Turin, Endocrinology Department, Turin, Italy; 21Hospital Clinic, Endocrinology Department, Barcelona, Spain; 22San Luigi Gonzaga Hospital, Dept of Biological Sciences, Orbassano, Italy; 23HRA-Pharma Rare Disease, Medical Department, Châtillon, France; 24Semmelweis University, Department of Internal Medicine and Oncology, Budapest, Hungary
Background
Retrospective studies led to European approval of the steroidogenesis inhibitor Metyrapone for the treatment of endogenous Cushing’s syndrome (CS). We prospectively showed good efficacy and safety of Metyrapone after 12 weeks (Wk12) treatment in the phase III/IV PROMPT study and now report results of an extension study (EXT) sponsored by HRA Pharma Rare Diseases.
Design
This was a single arm, open-label, 24Wk extension of PROMPT that enrolled patients whose mean of 3 UFC (mUFC) was normal or less than 2-fold the upper limit of normal (ULN, 165 nmol/d) at Wk12. The EXT measured UFC at Wk24 (for dose titration) and Wk36 by liquid chromatography tandem–mass spectrometry.
Results
At the end of PROMPT (Wk 12), mUFC was normal in 23 of 49 patients and < 2-fold ULN in 19. The EXT baseline median mUFC was 0.96-fold ULN (159, range 5 – 333 nmol/d, n = 41). At Wk36, median mUFC in 35 completers was 1.04-fold ULN: mUFC was normal in 17 patients, < 2 × ULN in 11 and ≥ 2× ULN in 7. mUFC at Wk36 was normal in 5/14 evaluable patients with mUFC 1–2× normal at Wk12. mUFC at Wk24 was normal in all 20 patients with normal Wk12 mUFC; at Wk36 12 maintained normal values, 4 had mUFC < 2 × ULN, and 4 had mUFC ≥ 2× ULN. PROMPT and EXT response rates were similar (80%, 95% CI 66–89 vs 71%, 95% CI 55–84). Wk36 metyrapone dose was higher in mUFC 2-fold ULN group than others (2357 vs 1618–1750 mg/d). Median late night salivary cortisol was 4.8-fold ULN at Wk0 and 1.7-fold ULN at Wk36; 27% were normal. Clinical improvement of physical symptoms, cardiovascular and metabolic parameters continued. Adverse events (n = 3: hirsutism, acute glaucoma or hypotension) or patient’s or physician’s decision (n = 3) prompted discontinuations. Compared to first 12-week period, good tolerability profile was maintained: no patient was treated for adrenal insufficiency and fewer patients reported nausea, vomiting, dizziness, or fatigue. There were 3 new cases of female hirsutism and one new case of hypertension.
Conclusions
mUFC was normal in 47–49% of completers at Wk12 and Wk36, and good tolerability continued. Normalization of mUFC during EXT validates continued titration after Wk12 in some patients. Variability of intra-patient steroidogenesis, baseline UFC and titration algorithms should be considered to improve overall UFC normalization. Late night salivary cortisol improvement was maintained during the extension and the distribution of metyrapone over the day should be considered to improve this rate.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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