NCT00600886

Safety and Efficacy of Pasireotide Long Acting Release (LAR) vs. Octreotide LAR in Patients With Active Acromegaly

Completed Phase 3 Results posted Last updated 2 July 2017

What this trial tests

Phase 3 trial testing Pasireotide in Acromegaly in 358 participants. Completed in 11 March 2016.

Timeline

11 February 2008

Primary endpoint
11 March 2016

11 March 2016

Quick facts

Lead sponsor	Novartis Pharmaceuticals
Phase	Phase 3
Status	Completed
Study type	INTERVENTIONAL
Allocation	randomized
Design	parallel
Masking	triple
Primary purpose	treatment
Enrollment	358
Start date	11 February 2008
Primary completion	11 March 2016
Estimated completion	11 March 2016
Sites	95 locations across Italy, Colombia, Taiwan, Poland, South Korea, Denmark, Netherlands, Russia

Drugs / interventions tested

• Pasireotide (PASIREOTIDE) — full drug profile →
• Octreotide (OCTREOTIDE) — full drug profile →

Conditions studied

• Acromegaly — all drugs for Acromegaly →

Sponsor

Novartis Pharmaceuticals — full company profile →

Who can join

18 and older, any sex, with Acromegaly. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Percentage of Participants With a Reduction of Mean GH Level to <2.5 μg/L and the Normalization of IGF-1 Primary · 12 months

Percentage of participants with a reduction of mean GH levels to \<2.5μg/L (based on a 5-point 2-hour profile) and normalization of sex- and age-adjusted IGF-1. Post surgery = patients with prior surgery but no previous medical treatment for acromegaly De novo = patients with de novo disease who refused pituitary surgery or for whom pituitary surgery was contraindicated.

Overall

Group	Value	95% CI
Pasireotide LAR (Core)	31.3	24.5 – 38.7
Octreotide LAR (Core)	19.2	13.8 – 25.7

Post Surgery

Group	Value	95% CI
Pasireotide LAR (Core)	39.4	28.0 – 51.7
Octreotide LAR (Core)	21.8	13.2 – 32.6

De novo

Group	Value	95% CI
Pasireotide LAR (Core)	25.7	17.7 – 35.2
Octreotide LAR (Core)	17.3	10.6 – 26.0

Percentage of Participants With a Reduction of Mean GH Level to < 2.5μg/L Secondary · 12 Months

Percentage of participants with a reduction of mean GH levels to \< 2.5μg/L (based on a 5-point 2-hour profile). Post surgery = patients with prior surgery but no previous medical treatment for acromegaly De novo = patients with de novo disease who refused pituitary surgery or for whom pituitary surgery was contraindicated.

Overall

Group	Value	95% CI
Pasireotide LAR (Core)	48.3	40.7 – 55.9
Octreotide LAR (Core)	51.6	44.1 – 59.1

Post surgery

Group	Value	95% CI
Pasireotide LAR (Core)	52.1	39.9 – 64.1
Octreotide LAR (Core)	51.3	39.7 – 62.8

De novo

Group	Value	95% CI
Pasireotide LAR (Core)	45.7	36.0 – 55.7
Octreotide LAR (Core)	51.9	41.9 – 61.8

Change From Baseline in Tumor Volume at 12 Months Secondary · Baseline, 12 Months

Absolute and percentage change from baseline in tumor volume (assessed by pituitary MRI) Post surgery = patients with prior surgery but no previous medical treatment for acromegaly De novo = patients with de novo disease who refused pituitary surgery or for whom pituitary surgery was contraindicated.

Overall at baseline

Group	Value	95% CI
Pasireotide LAR (Core)	2420.7	± 4159.21
Octreotide LAR (Core)	2259.2	± 3390.20

Overall % change at month 12

Group	Value	95% CI
Pasireotide LAR (Core)	-39.7	± 21.83
Octreotide LAR (Core)	-38.0	± 24.47

Post surgery at baseline

Group	Value	95% CI
Pasireotide LAR (Core)	2185.2	± 2861.09
Octreotide LAR (Core)	2196.5	± 3922.08

Post surgery % change at month 12

Group	Value	95% CI
Pasireotide LAR (Core)	-39.5	± 20.60
Octreotide LAR (Core)	-39.0	± 23.81

De novo at baseline

Group	Value	95% CI
Pasireotide LAR (Core)	2592.4	± 4901.99
Octreotide LAR (Core)	2308.1	± 2930.84

De novo % change at month 12

Group	Value	95% CI
Pasireotide LAR (Core)	-39.9	± 22.65
Octreotide LAR (Core)	-37.2	± 25.07

Overall absolute change at month 12

Group	Value	95% CI
Pasireotide LAR (Core)	-987.1	± 2448.14
Octreotide LAR (Core)	-801.2	± 1676.62

Post surgery abs. change at month 12

Group	Value	95% CI
Pasireotide LAR (Core)	-873.7	± 1282.06
Octreotide LAR (Core)	-713.8	± 1708.20

Percentage of Participants With Normalization of IGF-1 Secondary · 12 Months

Percentage of participants with normalization of sex- and age-adjusted IGF-1. Post surgery = patients with prior surgery but no previous medical treatment for acromegaly De novo = patients with de novo disease who refused pituitary surgery or for whom pituitary surgery was contraindicated.

Overall

Group	Value	95% CI
Pasireotide LAR (Core)	38.6	31.4 – 46.3
Octreotide LAR (Core)	23.6	17.7 – 30.5

Post surgery

Group	Value	95% CI
Pasireotide LAR (Core)	50.7	38.6 – 62.8
Octreotide LAR (Core)	26.9	17.5 – 38.2

De novo

Group	Value	95% CI
Pasireotide LAR (Core)	30.5	21.9 – 40.2
Octreotide LAR (Core)	21.2	13.8 – 30.3

Percentage of Participants With a Reduction of Mean GH Level to < 2.5μg/L and Normalization of IGF-1 Secondary · Months 3, 6, 9, 12, 16, 19, 22, 25

Percentage of participants with a reduction of mean GH levels to \< 2.5μg/L (based on a 5-point 2-hour profile) and normalization of sex- and age-adjusted IGF-1. Denominator for time points up to Month 12 is the Full Analysis Set (FAS). Denominator for time points after Month 12 excludes patients who completed the core and did not enter the extension. Patients who discontinued were considered non-responders for the time points after discontinuation, patients who crossed over were considered non-responders for all time points after crossover. Analysis was based on data up to crossover (i.e., i

Month 3

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	30.1	23.4 – 37.5
Octreotide LAR (Core & Extension)	21.4	15.7 – 28.1

Month 6

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	30.1	23.4 – 37.5
Octreotide LAR (Core & Extension)	19.8	14.3 – 26.3

Month 9

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	27.8	21.4 – 35.1
Octreotide LAR (Core & Extension)	23.1	17.2 – 29.9

Month 12

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	29.0	22.4 – 36.3
Octreotide LAR (Core & Extension)	17.6	12.3 – 23.9

Month 16

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	25.2	18.4 – 33.0
Octreotide LAR (Core & Extension)	12.4	7.6 – 18.7

Month 19

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	23.1	16.6 – 30.8
Octreotide LAR (Core & Extension)	13.7	8.7 – 20.2

Month 22

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	25.2	18.4 – 33.0
Octreotide LAR (Core & Extension)	16.3	10.9 – 23.2

Month 25

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	24.5	17.8 – 32.3
Octreotide LAR (Core & Extension)	13.7	8.7 – 20.2

Summary of Mean GH Values Secondary · Baseline, Months 3, 6, 9, 12, 16, 19, 22, 25

Mean GH levels (based on a 5-point profile over 2 hours). Analysis was based on data up to crossover (i.e., included data from both blinded core and extension phase up to 26 Months for patients who continued the same treatment in the extension. For patients who switched to the other treatment, only data collected before crossover was included).

Baseline

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	21.9	± 32.14
Octreotide LAR (Core & Extension)	18.8	± 25.95

Month 3

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	6.3	± 12.54
Octreotide LAR (Core & Extension)	5.8	± 12.87

Month 6

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	5.6	± 11.47
Octreotide LAR (Core & Extension)	5.2	± 10.99

Month 9

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	4.9	± 9.62
Octreotide LAR (Core & Extension)	4.3	± 9.70

Month 12

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	4.6	± 9.51
Octreotide LAR (Core & Extension)	4.5	± 11.34

Month 16

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	2.3	± 5.64
Octreotide LAR (Core & Extension)	1.4	± 1.49

Month 19

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	2.1	± 5.68
Octreotide LAR (Core & Extension)	1.5	± 1.68

Month 22

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	2.1	± 6.15
Octreotide LAR (Core & Extension)	1.4	± 1.43

Time to First Response for Patients Achieving a Reduction of Mean GH Level to < 2.5 μg/L and Normalization of IGF-1 (No. of Responders: Pasireotite LAR = 81, Octreotide LAR = 63) ) Secondary · Up to 26 months

Time to first response for patients achieving a reduction of mean GH level to \< 2.5 μg/L and normalization of IGF-1. Analysis was based on data up to crossover (i.e., included data from both blinded core and extension phase up to 26 Months for patients who continued the same treatment in the extension. For patients who switched to the other treatment, only data collected before crossover was included).

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	12.6	12.3 – 13.0
Octreotide LAR (Core & Extension)	12.4	12.3 – 13.7

Severity Scores of Acromegaly Symptoms Secondary · Baseline, Months 12, 25

Severity scores of acromegaly symptoms (Headache, Fatigue, Perspiration, Paresthesias, Osteoarthralgia). Symptoms were scored from 0 (no symptom) to 4 (very severe). Analysis was based on data up to crossover (i.e., included data from both blinded core and extension phase up to 26 Months for patients who continued the same treatment in the extension. For patients who switched to the other treatment, only data collected before crossover was included).

Headache - Baseline

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	0.9	± 1.05
Octreotide LAR (Core & Extension)	1.0	± 1.14

Fatigue - Baseline

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	1.2	± 1.13
Octreotide LAR (Core & Extension)	1.4	± 1.23

Perspiration - Baseline

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	1.1	± 1.21
Octreotide LAR (Core & Extension)	1.3	± 1.31

Paresthesia - Baseline

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	0.7	± 1.00
Octreotide LAR (Core & Extension)	0.8	± 1.15

Osteoarthraliga - Baseline

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	1.0	± 1.05
Octreotide LAR (Core & Extension)	1.3	± 1.26

Headache - M12

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	0.5	± 0.77
Octreotide LAR (Core & Extension)	0.6	± 0.79

Fatigue - M12

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	0.8	± 0.95
Octreotide LAR (Core & Extension)	0.7	± 0.99

Perspiration - M12

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	0.4	± 0.81
Octreotide LAR (Core & Extension)	0.5	± 0.91

Ring Size Secondary · Baseline, Months 12, 25

Ring size (based on jeweler's finger gauge). Analysis was based on data up to crossover (i.e., included data from both blinded core and extension phase up to 26 Months for patients who continued the same treatment in the extension. For patients who switched to the other treatment, only data collected before crossover was included).

Baseline left hand (LH) 4th digit

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	11.6	± 2.00
Octreotide LAR (Core & Extension)	11.8	± 1.97

Baseline left hand 5th digit

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	11.7	± 2.82
Octreotide LAR (Core & Extension)	12.4	± 2.88

Baseline right hand (RH) 4th digit

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	12.5	± 2.01
Octreotide LAR (Core & Extension)	11.4	± 2.54

Baseline right hand 5th digit

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	11.2	± 3.35
Octreotide LAR (Core & Extension)	11.3	± 2.95

M12 LH 4th digit

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	10.6	± 2.05
Octreotide LAR (Core & Extension)	11.1	± 1.95

M12 LH 5th digit

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	11.8	± 1.81
Octreotide LAR (Core & Extension)	12.4	± 1.78

M12 RH 4th digit

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	12.2	± 2.12
Octreotide LAR (Core & Extension)	11.3	± 2.18

M12 RH 5th digit

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	10.7	± 3.96
Octreotide LAR (Core & Extension)	10.5	± 2.14

Health-related Quality-of-life as Measured by the AcroQoL Questionnaire Secondary · Baseline, Months 12, 25

Acromegalyy quality of life (AcroQoL) total scores. The AcroQoL questionnaire is unidimensional and contains 22 items divided in two scales: one that evaluates physical aspects (eight items) and another one that evaluates psychological aspects (14 items). The scoring of the questionnaire was performed as specified by the instrument developers. Total scores range from 0 to 100. Higher scores represent better quality of life. Analysis was based on data up to crossover (i.e., included data from both blinded core and extension phase up to 26 Months for patients who continued the same treatment in

Baseline

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	58.4	± 19.97
Octreotide LAR (Core & Extension)	55.6	± 19.79

M12

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	65.7	± 21.64
Octreotide LAR (Core & Extension)	61.6	± 21.01

M25

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	69.3	± 18.76
Octreotide LAR (Core & Extension)	62.9	± 18.86

Summary of Prolactin Levels Secondary · Baseline, Months 12, 25

Prolactin Levels. Analysis was based on data up to crossover (i.e., included data from both blinded core and extension phase up to 26 Months for patients who continued the same treatment in the extension. For patients who switched to the other treatment, only data collected before crossover was included).

Baseline

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	20.6	± 53.00
Octreotide LAR (Core & Extension)	15.8	± 22.05

M12

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	8.9	± 19.24
Octreotide LAR (Core & Extension)	11.7	± 19.09

M25

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	5.4	± 4.37
Octreotide LAR (Core & Extension)	6.7	± 4.63

Duration of Response for Patients Achieving a Reduction of Mean GH Level to <2.5 μg/L and the Normalization of IGF-1 at Month 12 (No. of Responders: Pasireotide LAR = 51, Octreotide LAR = 32) Secondary · Up to 26 months

The duration of response is defined as the time from the date that patient first met and maintained the response criteria based on primary efficacy variable to the date that patient lost response status. Median and corresponding 95% CI are derived based on Kaplan-Meier method. Analysis was based on data up to crossover (i.e., included data from both blinded core and extension phase up to 26 Months for patients who continued the same treatment in the extension. For patients who switched to the other treatment, only data collected before crossover was included).

Group	Value	95% CI
Pasireotide LAR (Core & Extension)	64.4	52.1 – 100.4
Octreotide LAR (Core & Extension)	64.6	40.0 – 92.0

Adverse events — posted to ClinicalTrials.gov

Reporting threshold: 5%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Pasireotide LAR - up to 26 Months

Serious: 35/178 (20%)

Deaths: —

Octreotide LAR - up to 26 Months

Serious: 28/180 (16%)

Deaths: —

Crossed Over to Pasireotide LAR - up to 26 Months

Serious: 8/81 (10%)

Deaths: —

Crossed Over to Octreotide LAR - up to 26 Months

Serious: 6/38 (16%)

Deaths: —

Pasireotide LAR - up to EOS

Serious: 37/178 (21%)

Deaths: —

Crossed Over to Pasireotide LAR - up to EOS

Serious: 12/81 (15%)

Deaths: —

Serious adverse events (122 terms)

Reaction	System	Pasireotide LAR - up to 26…	Octreotide LAR - up to 26 …	Crossed Over to Pasireotid…	Crossed Over to Octreotide…	Pasireotide LAR - up to EOS	Crossed Over to Pasireotid…
Cholelithiasis	Hepatobiliary disorders	—	—	—	—	—	—
Cholecystitis acute	Hepatobiliary disorders	—	—	—	—	—	—
Diabetes mellitus	Metabolism and nutrition disorders	—	—	—	—	—	—
Acromegaly	Endocrine disorders	—	—	—	—	—	—
Abdominal pain upper	Gastrointestinal disorders	—	—	—	—	—	—
Constipation	Gastrointestinal disorders	—	—	—	—	—	—
Concomitant disease progression	General disorders	—	—	—	—	—	—
Cholecystitis	Hepatobiliary disorders	—	—	—	—	—	—
Blood creatine phosphokinase increased	Investigations	—	—	—	—	—	—
Osteoarthritis	Musculoskeletal and connective tissue disorders	—	—	—	—	—	—
Nephrolithiasis	Renal and urinary disorders	—	—	—	—	—	—
Neutropenia	Blood and lymphatic system disorders	—	—	—	—	—	—
Acute myocardial infarction	Cardiac disorders	—	—	—	—	—	—
Angina unstable	Cardiac disorders	—	—	—	—	—	—
Atrial fibrillation	Cardiac disorders	—	—	—	—	—	—
Cardiac arrest	Cardiac disorders	—	—	—	—	—	—
Cardiovascular disorder	Cardiac disorders	—	—	—	—	—	—
Myocardial infarction	Cardiac disorders	—	—	—	—	—	—
Myocardial ischaemia	Cardiac disorders	—	—	—	—	—	—
Hypoacusis	Ear and labyrinth disorders	—	—	—	—	—	—
Adrenal insufficiency	Endocrine disorders	—	—	—	—	—	—
Toxic nodular goitre	Endocrine disorders	—	—	—	—	—	—
Abdominal pain	Gastrointestinal disorders	—	—	—	—	—	—
Anal fissure	Gastrointestinal disorders	—	—	—	—	—	—
Colitis	Gastrointestinal disorders	—	—	—	—	—	—

Other adverse events (67 terms — click to expand)

Reaction	System	Pasireotide LAR - up to 26…	Octreotide LAR - up to 26 …	Crossed Over to Pasireotid…	Crossed Over to Octreotide…	Pasireotide LAR - up to EOS	Crossed Over to Pasireotid…
Diarrhoea	Gastrointestinal disorders	—	—	—	—	—	—
Cholelithiasis	Hepatobiliary disorders	—	—	—	—	—	—
Hyperglycaemia	Metabolism and nutrition disorders	—	—	—	—	—	—
Headache	Nervous system disorders	—	—	—	—	—	—
Abdominal pain	Gastrointestinal disorders	—	—	—	—	—	—
Nausea	Gastrointestinal disorders	—	—	—	—	—	—
Diabetes mellitus	Metabolism and nutrition disorders	—	—	—	—	—	—
Alopecia	Skin and subcutaneous tissue disorders	—	—	—	—	—	—
Nasopharyngitis	Infections and infestations	—	—	—	—	—	—
Blood creatine phosphokinase increased	Investigations	—	—	—	—	—	—
Arthralgia	Musculoskeletal and connective tissue disorders	—	—	—	—	—	—
Back pain	Musculoskeletal and connective tissue disorders	—	—	—	—	—	—
Abdominal distension	Gastrointestinal disorders	—	—	—	—	—	—
Vomiting	Gastrointestinal disorders	—	—	—	—	—	—
Dizziness	Nervous system disorders	—	—	—	—	—	—
Fatigue	General disorders	—	—	—	—	—	—
Hypertension	Vascular disorders	—	—	—	—	—	—
Upper respiratory tract infection	Infections and infestations	—	—	—	—	—	—
Anaemia	Blood and lymphatic system disorders	—	—	—	—	—	—
Constipation	Gastrointestinal disorders	—	—	—	—	—	—
Influenza	Infections and infestations	—	—	—	—	—	—
Blood glucose increased	Investigations	—	—	—	—	—	—
Abdominal pain upper	Gastrointestinal disorders	—	—	—	—	—	—
Cough	Respiratory, thoracic and mediastinal disorders	—	—	—	—	—	—
Alanine aminotransferase increased	Investigations	—	—	—	—	—	—
Pain in extremity	Musculoskeletal and connective tissue disorders	—	—	—	—	—	—
Sinus bradycardia	Cardiac disorders	—	—	—	—	—	—
Oropharyngeal pain	Respiratory, thoracic and mediastinal disorders	—	—	—	—	—	—
Injection site pain	General disorders	—	—	—	—	—	—
Hypoglycaemia	Metabolism and nutrition disorders	—	—	—	—	—	—
Bronchitis	Infections and infestations	—	—	—	—	—	—
Aspartate aminotransferase increased	Investigations	—	—	—	—	—	—
Lipase increased	Investigations	—	—	—	—	—	—
Urinary tract infection	Infections and infestations	—	—	—	—	—	—
Glycosylated haemoglobin increased	Investigations	—	—	—	—	—	—
Type 2 diabetes mellitus	Metabolism and nutrition disorders	—	—	—	—	—	—
Insomnia	Psychiatric disorders	—	—	—	—	—	—
Flatulence	Gastrointestinal disorders	—	—	—	—	—	—
Pyrexia	General disorders	—	—	—	—	—	—
Hepatic steatosis	Hepatobiliary disorders	—	—	—	—	—	—

Most-reported serious reactions: Cholelithiasis, Cholecystitis acute, Diabetes mellitus, Acromegaly, Abdominal pain upper, Constipation, Concomitant disease progression, Cholecystitis.

Data from ClinicalTrials.gov NCT00600886 adverse events section.

Sponsor's own description

The patients received either Pasireotide LAR or Octreotide LAR for one year of treatment.

The objective of this study was to compare the proportion of patients with a reduction of mean GH level to \<2.5 µg/L and the normalization of IGF-1 to within normal limits (age and sex related) between the two treatment groups (pasireotide LAR and octreotide LAR) at 12 months.

Following one year of treatment patients could proceed into the study extension.

Patients who did not respond to the treatment they were randomized to (based on month 12 assessment results) were switched to the other treatment arm at month 13.

Publications & conference data

6 peer-reviewed publications reference this trial (live from Europe PMC):

1. Pasireotide versus octreotide in acromegaly: a head-to-head superiority study.
   Colao A, Bronstein MD, Freda P, Gu F, et al · · 2014 · cited 268× · PMID 24423324 · DOI 10.1210/jc.2013-2480
2. Pasireotide LAR maintains inhibition of GH and IGF-1 in patients with acromegaly for up to 25 months: results from the blinded extension phase of a randomized, double-blind, multicenter, Phase III study.
   Sheppard M, Bronstein MD, Freda P, Serri O, et al · · 2015 · cited 63× · PMID 25103549 · DOI 10.1007/s11102-014-0585-6
3. Switching patients with acromegaly from octreotide to pasireotide improves biochemical control: crossover extension to a randomized, double-blind, Phase III study.
   Bronstein MD, Fleseriu M, Neggers S, Colao A, et al · · 2016 · cited 59× · PMID 27039081 · DOI 10.1186/s12902-016-0096-8
4. Therapeutic options in the management of acromegaly: focus on lanreotide Autogel.
   Roelfsema F, Biermasz NR, Pereira AM, Romijn JA. · · 2008 · cited 14× · PMID 19707377 · DOI 10.2147/btt.s3356
5. HISTORICAL RESPONSE RATES OF SOMATOSTATIN ANALOGUES IN THE TREATMENT OF ACROMEGALY: A SYSTEMATIC REVIEW.
   Shanik MH, Cao PD, Ludlam WH. · · 2016 · cited 11× · PMID 26437217 · DOI 10.4158/ep15913.ra
6. Successful debulking of plurihormonal pituitary macroadenoma with long-acting pasireotide and dopamine agonist combination therapy.
   Jerkins TW, Jerkins RK, Franklin R. · · 2019 · cited 1× · PMID 30899469 · DOI 10.1002/ccr3.1961