Treatment of Pituitary-Dependent Cushing’s Disease with the Multireceptor Ligand Somatostatin Analog Pasireotide (SOM230): A Multicenter, Phase II Trial

Context: There is currently no medical therapy for Cushing’s disease that targets the pituitary adenoma. Availability of such a medical therapy would be a valuable therapeutic option for the management of this disorder. Objective: Our objective was to evaluate the short-term efficacy of the novel mu...

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Veröffentlicht in:The journal of clinical endocrinology and metabolism 2009-01, Vol.94 (1), p.115-122
Hauptverfasser: Boscaro, M., Ludlam, W. H., Atkinson, B., Glusman, J. E., Petersenn, S., Reincke, M., Snyder, P., Tabarin, A., Biller, B. M. K., Findling, J., Melmed, S., Darby, C. H., Hu, K., Wang, Y., Freda, P. U., Grossman, A. B., Frohman, L. A., Bertherat, J.
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container_end_page 122
container_issue 1
container_start_page 115
container_title The journal of clinical endocrinology and metabolism
container_volume 94
creator Boscaro, M.
Ludlam, W. H.
Atkinson, B.
Glusman, J. E.
Petersenn, S.
Reincke, M.
Snyder, P.
Tabarin, A.
Biller, B. M. K.
Findling, J.
Melmed, S.
Darby, C. H.
Hu, K.
Wang, Y.
Freda, P. U.
Grossman, A. B.
Frohman, L. A.
Bertherat, J.
description Context: There is currently no medical therapy for Cushing’s disease that targets the pituitary adenoma. Availability of such a medical therapy would be a valuable therapeutic option for the management of this disorder. Objective: Our objective was to evaluate the short-term efficacy of the novel multireceptor ligand somatostatin analog pasireotide in patients with de novo, persistent, or recurrent Cushing’s disease. Design: We conducted a phase II, proof-of-concept, open-label, single-arm, 15-d multicenter study. Patients: Thirty-nine patients with either de novo Cushing’s disease who were candidates for pituitary surgery or with persistent or recurrent Cushing’s disease after surgery without having received prior pituitary irradiation. Intervention: Patients self-administered sc pasireotide 600 μg twice daily for 15 d. Main Outcome Measure: Normalization of urinary free cortisol (UFC) levels after 15 d treatment was the main outcome measure. Results: Of the 29 patients in the primary efficacy analysis, 22 (76%) showed a reduction in UFC levels, of whom five (17%) had normal UFC levels (responders), after 15 d of treatment with pasireotide. Serum cortisol levels and plasma ACTH levels were also reduced. Steady-state plasma concentrations of pasireotide were achieved within 5 d of treatment. Responders appeared to have higher pasireotide exposure than nonresponders. Conclusions: Pasireotide produced a decrease in UFC levels in 76% of patients with Cushing’s disease during the treatment period of 15 d, with direct effects on ACTH release. These results suggest that pasireotide holds promise as an effective medical treatment for this disorder. Results from this phase II study show pasireotide to be a promising pituitary-directed medical therapy for patients with Cushing’s disease.
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H. ; Atkinson, B. ; Glusman, J. E. ; Petersenn, S. ; Reincke, M. ; Snyder, P. ; Tabarin, A. ; Biller, B. M. K. ; Findling, J. ; Melmed, S. ; Darby, C. H. ; Hu, K. ; Wang, Y. ; Freda, P. U. ; Grossman, A. B. ; Frohman, L. A. ; Bertherat, J.</creator><creatorcontrib>Boscaro, M. ; Ludlam, W. H. ; Atkinson, B. ; Glusman, J. E. ; Petersenn, S. ; Reincke, M. ; Snyder, P. ; Tabarin, A. ; Biller, B. M. K. ; Findling, J. ; Melmed, S. ; Darby, C. H. ; Hu, K. ; Wang, Y. ; Freda, P. U. ; Grossman, A. B. ; Frohman, L. A. ; Bertherat, J.</creatorcontrib><description>Context: There is currently no medical therapy for Cushing’s disease that targets the pituitary adenoma. Availability of such a medical therapy would be a valuable therapeutic option for the management of this disorder. Objective: Our objective was to evaluate the short-term efficacy of the novel multireceptor ligand somatostatin analog pasireotide in patients with de novo, persistent, or recurrent Cushing’s disease. Design: We conducted a phase II, proof-of-concept, open-label, single-arm, 15-d multicenter study. Patients: Thirty-nine patients with either de novo Cushing’s disease who were candidates for pituitary surgery or with persistent or recurrent Cushing’s disease after surgery without having received prior pituitary irradiation. Intervention: Patients self-administered sc pasireotide 600 μg twice daily for 15 d. Main Outcome Measure: Normalization of urinary free cortisol (UFC) levels after 15 d treatment was the main outcome measure. Results: Of the 29 patients in the primary efficacy analysis, 22 (76%) showed a reduction in UFC levels, of whom five (17%) had normal UFC levels (responders), after 15 d of treatment with pasireotide. Serum cortisol levels and plasma ACTH levels were also reduced. Steady-state plasma concentrations of pasireotide were achieved within 5 d of treatment. Responders appeared to have higher pasireotide exposure than nonresponders. 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Psychology ; Glucagon - blood ; Hormones ; Humans ; Hydrocortisone - urine ; Hypothalamus. Hypophysis. Epiphysis (diseases) ; Insulin - blood ; Ligands ; Male ; Medical sciences ; Medical treatment ; Middle Aged ; Nervous system diseases ; Non tumoral diseases. Target tissue resistance. 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H.</creatorcontrib><creatorcontrib>Atkinson, B.</creatorcontrib><creatorcontrib>Glusman, J. E.</creatorcontrib><creatorcontrib>Petersenn, S.</creatorcontrib><creatorcontrib>Reincke, M.</creatorcontrib><creatorcontrib>Snyder, P.</creatorcontrib><creatorcontrib>Tabarin, A.</creatorcontrib><creatorcontrib>Biller, B. M. K.</creatorcontrib><creatorcontrib>Findling, J.</creatorcontrib><creatorcontrib>Melmed, S.</creatorcontrib><creatorcontrib>Darby, C. H.</creatorcontrib><creatorcontrib>Hu, K.</creatorcontrib><creatorcontrib>Wang, Y.</creatorcontrib><creatorcontrib>Freda, P. U.</creatorcontrib><creatorcontrib>Grossman, A. B.</creatorcontrib><creatorcontrib>Frohman, L. A.</creatorcontrib><creatorcontrib>Bertherat, J.</creatorcontrib><title>Treatment of Pituitary-Dependent Cushing’s Disease with the Multireceptor Ligand Somatostatin Analog Pasireotide (SOM230): A Multicenter, Phase II Trial</title><title>The journal of clinical endocrinology and metabolism</title><addtitle>J Clin Endocrinol Metab</addtitle><description>Context: There is currently no medical therapy for Cushing’s disease that targets the pituitary adenoma. Availability of such a medical therapy would be a valuable therapeutic option for the management of this disorder. Objective: Our objective was to evaluate the short-term efficacy of the novel multireceptor ligand somatostatin analog pasireotide in patients with de novo, persistent, or recurrent Cushing’s disease. Design: We conducted a phase II, proof-of-concept, open-label, single-arm, 15-d multicenter study. Patients: Thirty-nine patients with either de novo Cushing’s disease who were candidates for pituitary surgery or with persistent or recurrent Cushing’s disease after surgery without having received prior pituitary irradiation. Intervention: Patients self-administered sc pasireotide 600 μg twice daily for 15 d. Main Outcome Measure: Normalization of urinary free cortisol (UFC) levels after 15 d treatment was the main outcome measure. Results: Of the 29 patients in the primary efficacy analysis, 22 (76%) showed a reduction in UFC levels, of whom five (17%) had normal UFC levels (responders), after 15 d of treatment with pasireotide. Serum cortisol levels and plasma ACTH levels were also reduced. Steady-state plasma concentrations of pasireotide were achieved within 5 d of treatment. Responders appeared to have higher pasireotide exposure than nonresponders. 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Benign neoplasms</subject><subject>Oligopeptides - adverse effects</subject><subject>Oligopeptides - pharmacokinetics</subject><subject>Oligopeptides - therapeutic use</subject><subject>Patients</subject><subject>Pituitary</subject><subject>Pituitary ACTH Hypersecretion - drug therapy</subject><subject>Pituitary ACTH Hypersecretion - metabolism</subject><subject>Somatostatin</subject><subject>Somatostatin - analogs &amp; derivatives</subject><subject>Surgery</subject><subject>Vertebrates: anatomy and physiology, studies on body, several organs or systems</subject><subject>Vertebrates: endocrinology</subject><issn>0021-972X</issn><issn>1945-7197</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10VuL1DAYBuAiijuu3nktAVkPsF1zaNPGu2HWw8AsO7AjeFeyydeZDG1TkxTxzr-hP89fYkqLC6I3CYSH90vyJslTgi8IJfjNUV1QjMuUxOVesiAiy9OCiOJ-ssCYklQU9PNJ8sj7I8Yky3L2MDkhpciLHPNF8nPnQIYWuoBsjbYmDCZI9y29hB46PR6vBn8w3f7X9x8eXRoP0gP6asIBhQOgq6EJxoGCPliHNmYvO41ubCuD9UEG06FlJxu7R1vpo7PBaECvbq6vKMOv36LlFKDiHHDnaHsYw9drtHNGNo-TB7VsPDyZ99Pk0_t3u9XHdHP9Yb1ablKVcRJSwnOtFdNc55AJUFopxnOCoaYK35a00EzhsigLTWmhyporIkZRM8YZFTk7TV5Mub2zXwbwoWqNV9A0sgM7-IrzQvBMlBE-_wse7eDi-3zFCM-YKDDDUZ1PSjnrvYO66p1p459WBFdjY9VRVWNj1dhY5M_m0OG2BX2H54oiOJuB9Eo2tZOdMv6Pi4GUMEGiezk5O_T_G5nOI9kkY8NWOdNB78D7u9f886K_AWAAu9s</recordid><startdate>200901</startdate><enddate>200901</enddate><creator>Boscaro, M.</creator><creator>Ludlam, W. 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Results: Of the 29 patients in the primary efficacy analysis, 22 (76%) showed a reduction in UFC levels, of whom five (17%) had normal UFC levels (responders), after 15 d of treatment with pasireotide. Serum cortisol levels and plasma ACTH levels were also reduced. Steady-state plasma concentrations of pasireotide were achieved within 5 d of treatment. Responders appeared to have higher pasireotide exposure than nonresponders. Conclusions: Pasireotide produced a decrease in UFC levels in 76% of patients with Cushing’s disease during the treatment period of 15 d, with direct effects on ACTH release. These results suggest that pasireotide holds promise as an effective medical treatment for this disorder. 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subjects Adrenocorticotropic hormone
Adrenocorticotropic Hormone - blood
Adult
Aged
Biological and medical sciences
Blood Glucose - analysis
Cortisol
Endocrinopathies
Feeding. Feeding behavior
Female
Fundamental and applied biological sciences. Psychology
Glucagon - blood
Hormones
Humans
Hydrocortisone - urine
Hypothalamus. Hypophysis. Epiphysis (diseases)
Insulin - blood
Ligands
Male
Medical sciences
Medical treatment
Middle Aged
Nervous system diseases
Non tumoral diseases. Target tissue resistance. Benign neoplasms
Oligopeptides - adverse effects
Oligopeptides - pharmacokinetics
Oligopeptides - therapeutic use
Patients
Pituitary
Pituitary ACTH Hypersecretion - drug therapy
Pituitary ACTH Hypersecretion - metabolism
Somatostatin
Somatostatin - analogs & derivatives
Surgery
Vertebrates: anatomy and physiology, studies on body, several organs or systems
Vertebrates: endocrinology
title Treatment of Pituitary-Dependent Cushing’s Disease with the Multireceptor Ligand Somatostatin Analog Pasireotide (SOM230): A Multicenter, Phase II Trial
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