Department of Internal Medicine, Endocrinology Section, Pituitary Center Rotterdam, Erasmus University Medical Center, CB Rotterdam, Netherlands.
J Clin Endocrinol Metab. 2019 Jun 1;104(6):1978-1988. doi: 10.1210/jc.2018-01979.
Pasireotide long-acting release (LAR) is a somatostatin multireceptor ligand, and in the current consensus criteria pasireotide LAR is considered the second-line medical treatment for acromegaly. We present in this article our recommendations to define the position of pasireotide LAR in the treatment of acromegaly and provide recommendations for the management of pasireotide-induced hyperglycemia.
Our recommendations are based on our experiences with the pasireotide LAR and pegvisomant (PEGV) combination study and the available basic or clinical articles published in peer-reviewed international journals on pasireotide LAR and acromegaly.
In accordance with the current consensus criteria, we recommend pasireotide LAR monotherapy as a second-line therapy in young patients who show tumor growth during first-generation somatostatin receptor ligand (SRL) therapy and in patients who show tumor growth during PEGV therapy. In addition, we recommend pasireotide LAR monotherapy in patients with headache not responsive to first-generation SRL therapy and in patients who experience side effects or are intolerant to PEGV monotherapy. In contrast to the current consensus criteria, we recommend considering combination therapy with pasireotide LAR and PEGV as third-line treatment in patients without diabetes at low PEGV dosages (≤80 mg/week) and in patients with tumor growth or symptoms of active acromegaly during first-generation SRL and PEGV combination therapy. With respect to pasireotide-induced hyperglycemia, we recommend a more liberal strategy of blood glucose monitoring during pasireotide treatment.
In contrast to the current consensus criteria, we recommend a more reluctant use of pasireotide LAR therapy for the treatment of acromegaly.
帕瑞肽长效释放剂（LAR）是一种生长抑素多受体配体，在当前的共识标准中，帕瑞肽 LAR 被认为是肢端肥大症的二线治疗药物。本文中，我们提出了将帕瑞肽 LAR 用于治疗肢端肥大症的建议，并提供了管理帕瑞肽诱导的高血糖的建议。
我们的建议是基于我们在帕瑞肽 LAR 和培维索孟（PEGV）联合研究中的经验，以及在同行评议的国际期刊上发表的关于帕瑞肽 LAR 和肢端肥大症的可用基础或临床文章。
根据当前的共识标准，我们建议在第一代生长抑素受体配体（SRL）治疗期间肿瘤生长的年轻患者和在 PEGV 治疗期间肿瘤生长的患者中，将帕瑞肽 LAR 单药治疗作为二线治疗。此外，我们建议在对第一代 SRL 治疗无反应的头痛患者以及对 PEGV 单药治疗不耐受或有不良反应的患者中，使用帕瑞肽 LAR 单药治疗。与当前的共识标准不同，我们建议在低 PEGV 剂量（≤80mg/周）且无糖尿病的患者中，以及在第一代 SRL 和 PEGV 联合治疗期间肿瘤生长或有肢端肥大症症状的患者中，将帕瑞肽 LAR 和 PEGV 的联合治疗作为三线治疗。关于帕瑞肽引起的高血糖，我们建议在使用帕瑞肽治疗期间更自由地监测血糖。
与当前的共识标准不同，我们建议在治疗肢端肥大症时更不情愿地使用帕瑞肽 LAR 治疗。
