A 12-month phase 3 study of pasireotide in Cushing's disease
Open accessAbstract
BACKGROUND: Cushing's disease is associated with high morbidity and mortality. Pasireotide, a potential therapy, has a unique, broad somatostatin-receptor-binding profile, with high binding affinity for somatostatin-receptor subtype 5. METHODS: In this double-blind, phase 3 study, we randomly assigned 162 adults with Cushing's disease and a urinary free cortisol level of at least 1.5 times the upper limit of the normal range to receive subcutaneous pasireotide at a dose of 600 μg (82 patients) or 900 μg (80 patients) twice daily. Patients with urinary free cortisol not exceeding 2 times the upper limit of the normal range and not exceeding the baseline level at month 3 continued to receive their randomly assigned dose; all others received an additional 300 μg twice daily. The primary end point was a urinary free cortisol level at or below the upper limit of the normal range at month 6 without an increased dose. Open-label treatment continued through month 12. RESULTS: Twelve of the 82 patients in the 600-μg group and 21 of the 80 patients in the 900-μg group met the primary end point. The median urinary free cortisol level decreased by approximately 50% by month 2 and remained stable in both groups. A normal urinary free cortisol level was achieved more frequently in patients with baseline levels not exceeding 5 times the upper limit of the normal range than in patients with higher baseline levels. Serum and salivary cortisol and plasma corticotropin levels decreased, and clinical signs and symptoms of Cushing's disease diminished. Pasireotide was associated with hyperglycemia-related adverse events in 118 of 162 patients; other adverse events were similar to those associated with other somatostatin analogues. Despite declines in cortisol levels, blood glucose and glycated hemoglobin levels increased soon after treatment initiation and then stabilized; treatment with a glucose-lowering medication was initiated in 74 of 162 patients. CONCLUSIONS: The significant decrease in cortisol levels in patients with Cushing's disease who received pasireotide supports its potential use as a targeted treatment for corticotropin-secreting pituitary adenomas. (Funded by Novartis Pharma; ClinicalTrials.gov number, NCT00434148.).
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Mean UFC is routinely used in clinical practice and research to monitor disease control and treatment response in patients with CS treated with medical therapy.
“Mean UFC is routinely used in clinical practice and research to monitor disease control and treatment response in patients with CS treated with medical therapy (129-137).”
From Measuring cortisol in Cushing syndrome: diagnosis, monitoring, and cortisol circadian rhythm improvement. (2026) · cites this paper as [136]
The End Points and Assessments section (page not provided) says the pasireotide trial repeatedly measured urinary free cortisol as the mean of multiple samples; the Urinary Free Cortisol section uses those measurements to assess treatment response. This supports its use in research, but the paper does not establish that mean UFC is routinely used in clinical practice or across medically treated Cushing’s syndrome, beyond the Cushing’s disease patients studied here. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe restoration of cortisol circadian rhythm following medical therapy has not been investigated or established for most medications used to treat CS, and it is not routinely measured to determine treatment response.
“The restoration of cortisol circadian rhythm following medical therapy has not been investigated or established for most medications used to treat CS, and it is not routinely measured to determine treatment response (129-137).”
From Measuring cortisol in Cushing syndrome: diagnosis, monitoring, and cortisol circadian rhythm improvement. (2026) · cites this paper as [136]
In END POINTS AND ASSESSMENTS (page not available), this pasireotide trial defines treatment response by normalized urinary free cortisol, not restoration of circadian rhythm. It also measures morning serum and midnight salivary cortisol as secondary outcomes. The trial does not establish whether circadian-rhythm restoration has been investigated for most CS medications or whether it is routinely measured in practice. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn clinical trials, the efficacy of steroidogenesis inhibitors and pituitary-directed therapies in patients with CS was primarily evaluated by normalization of cortisol secretion per UFC.
“In clinical trials, the efficacy of steroidogenesis inhibitors and pituitary-directed therapies in patients with CS was primarily evaluated by the normalization of cortisol secretion per UFC (129-137).”
From Measuring cortisol in Cushing syndrome: diagnosis, monitoring, and cortisol circadian rhythm improvement. (2026) · cites this paper as [136]
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- Authors
- Colao, A., Petersenn, S., Newell-Price, J., Findling, J. W., Gu, F., Maldonado, M., Schoenherr, U., Dipl.-Biol., Mills, D., Salgado, L. R., & Biller, B. M. K.
- Affiliations
- Federico II University Hospital (IT)
- University of Duisburg-Essen (DE)
- University of Sheffield (GB)
- Medical College of Wisconsin (US)
- Peking Union Medical College Hospital (CN)
- Novartis (Switzerland) (CH)
- Universidade de São Paulo (BR)
- Massachusetts General Hospital (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2012-03-08
- Volume
- 366
- Issue
- 10
- Pages
- 914-924
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2133418708
- Semantic Scholar
- d3443b929babd2daf7d6ae90395d546356fda173
- Cited by
- 628
- References
- 22
- Citations by year
- 2026: 13 · 2025: 31 · 2024: 28 · 2023: 28 · 2022: 33 · 2021: 35 · 2020: 32 · 2019: 41 · 2018: 46 · 2017: 46 · 2016: 52 · 2015: 66 · 2014: 68 · 2013: 77 · 2012: 29
- FWCI
- 61.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Scientific Electronic Library Online (São Paulo Research Foundation, Latin American and Caribbean Center on Health Sciences Information, Conselho Nacional de Desenvolvimento Científico e Tecnológico) (publishedVersion)
- HAL (submittedVersion)
- Universitätsbibliographie, Universität Duisburg-Essen (submittedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- pasireotide, Cushing's disease, somatostatin receptor type 5, somatostatin analogues, urinary free cortisol, hypercortisolism, hyperglycemia, HbA1c, dose escalation
- MeSH terms
- Adolescent, Adrenocorticotropic Hormone, Adult, Aged, Child, Double-Blind Method, Female, Humans, Hydrocortisone, Male, Middle Aged, Recurrence, Saliva, Somatostatin, Pituitary ACTH Hypersecretion, Young Adult
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