How to manage pasireotide, when using as medical treatment for Cushing’s disease

Excerpt

Cushing’s disease (CD) is associated with significant morbidity and mortality, and therefore requires early intervention applying effective treatment. Transsphenoidal surgery is clearly the first-line therapy, with remission rates between 65 and 90 % in microadenomas, but somehow lower rates <65 % in macroadenomas. Second-line therapies include repeated surgery, various forms of medical treatment, radiation, and ultimately bilateral adrenalectomy. Several compounds have demonstrated some efficacy to lower cortisol excess in CD. They can be divided by their approaches targeting either the underlying corticotropic adenoma, the adrenal gland, or the peripheral glucocorticoid receptor. Unfortunately, there is no clear consensus for any of these second-line options, when and in which order they should be applied. Larger studies comparing several lines of treatment in a randomized fashion are hindered by the rarity of the disease. However, considering the relevant recurrence rates of CD after surgery [1], combined approaches applied simultaneously or in succession are necessary in many patients. To improve morbidity and mortality, those treatment options need to be analyzed with respect to their efficacy to normalize biochemical excess, tumor proliferation, and clinical consequences of the disease including quality of life. As none of the currently available treatment options except for surgery and potentially radiation is able to cure CD, side effects especially during long-term therapy are of special interest. …