Endocrine Abstracts

Background: Acromegaly is an uncommon chronic endocrine disorder which is associated with considerable comorbidities. Many patients fail to achieve biochemical control with current medical therapies, including surgery and first-generation somatostatin analogs. We aimed to perform a systematic review and single-arm meta-analysis to evaluate the efficacy of the multi-receptor ligand somatostatin analog Pasireotide in patients with acromegaly.

Methods: We systematically searched PubMed, EMBASE, and Cochrane databases for studies that assessed the efficacy of Pasireotide in patients with acromegaly and reported the outcomes of (1) biochemical control and its composite indicators; (2) normalized IGF-1 level and (3) GH< 2.5 mg/l. Random effect models were used for all Statistical analysis, which were conducted using R software. Heterogeneity was assessed with I2 statistics.

Results: We included twelve studies with a total of 664 patients: eight clinical trials and four observational cohorts. The overall population consisted of 67% of inadequately controlled acromegaly patients. In a pooled analysis, the biochemical control rate was 30% (95% CI: 16; 49). The frequency of normalization of IGF-1 and reduction of GH level were 45% (95% CI: 33; 57) and 34% (95% CI: 24; 45) respectively. A long-term effect (>12 months) of Pasireotide on biochemical control was observed, with a rate of 45% (95% CI: 26; 65). The most commonly reported adverse events were hyperglycemia in 42% (95% CI: 25; 59) and gastrointestinal disturbances in 41% (95% CI: 16; 71) of patients. Moreover, Pasireotide treatment was associated with a 31% (95% CI: 22; 41) incidence of new-onset diabetes mellitus.

Conclusion: Our findings suggest that Pasireotide has superior efficacy in patients with acromegaly. Although a high rate of hyperglycemic adverse events and diabetes mellitus related to treatment were observed, most of them were manageable.