Effects of pasireotide treatment on coagulative profile: a prospective study in patients with Cushing's disease

Introduction Cushing's disease (CD) is characterized by procoagulative profile. Treatment with cortisol-reducing medications might normalize the coagulation impairment potentially eliminating the risk of thromboembolic complications. Aim The aim of this prospective study is to evaluate the effectiveness of 6-12 months of treatment with pasireotide (Signifor (R), Novartis) 600 mu g twice daily on coagulative factors in 21 patients (16 females, mean age 46 +/- 12.2 years) with CD. Biochemical, hormonal (urinary free cortisol, UFC; late night salivary cortisol, LNSC; ACTH) and coagulative parameters as Protrombin time (PT), aPTT, factors VIII, IX and XI, antithrombin III, protein C, protein S, fibrinogen, were evaluated at baseline and during therapy. Results UFC showed a significant reduction from baseline (3.2 +/- 1.8 vs. 1.0 +/- 0.8, p < 0.0001) with normalization in 13/21 (61.9%) and in 7/16 (43.8%) at 6 and 12 months, respectively. On the same way LNSC returned to normal in 5/11 at 6 months, showing a trend to reduction (8.6 +/- 5 vs. 4.1 +/- 2.9), even though without statistical significance (p = 0.07). Throughout the treatment period there was an increase in serum glycaemia (5.5 +/- 2.3 vs. 6.8 +/- 2.3 mmol/L, p = 0.09), with a concomitant significant increase in HbA1c after 6 months (40.7 +/- 8.4 vs. 50.7 +/- 12.3 mmol/mol, p = 0.006). Regarding coagulative parameters, no differences were found neither in clotting nor in anticoagulant factors during therapy. No patients developed thrombotic complication during treatment. Conclusions Pasireotide resulted an effective treatment in controlling hypercortisolism in more than half of CD patients with partial restoration also of circadian cortisol secretion. No significant improvements were observed on clotting factors; this fact might depend on persistence of typical alteration of CD, such as obesity and hypertension, and reflects also on the worsening in glucide metabolism induced by the drug. Clinical implications of persistent procoagulative impairment while on medical therapy should be considered.