Pasireotide in Patients With Acromegaly Inadequately Controlled With First Generation Somatostatin Analogues

Inclusion Criteria

• Written informed consent
• Male and female patients ≥18 years
• Patients with confirmed diagnosis of inadequately controlled acromegaly (mean GH concentration ≥1 μg/L and sex- and age-adjusted IGF-1 >1.3 x ULN)
• Patients treated with octreotide LAR (30 mg or 40 mg) or lanreotide ATG (120 mg) monotherapy for at least 3 months prior to screening

Exclusion Criteria

• Concomitant treatment with other medications reducing GH and or IGF-1, unless discontinued 3 months prior to screening
• Patients with compression of the optic chiasm requiring surgical intervention
• Diabetic patients with HbA1c >8% at screening
• Patients who are hypothyroid and not on adequate replacement therapy
• Patients with symptomatic cholelithiasis and acute or chronic pancreatitis
• Patients with clinically significant valvular disease
• Patients with risk factors for torsade de pointes (TdP)
• Hypokalaemia, hypomagnesaemia, uncontrolled hypothyroidism, family history of long QT syndrome or concomitant medications with known risk of TdP
• Patients with congestive heart failure (NYHA Class III or IV), unstable angina, sustained ventricular tachycardia, clinically significant bradycardia, advanced heart block, history of acute MI less than one year prior to study entry or clinically significant impairment in cardiovascular function.
• Concomitant disease(s) that could prolong the QT interval such as autonomic neuropathy (caused by diabetes or Parkinson's disease), HIV, cirrhosis, uncontrolled hypothyroidism or cardiac failure
• Patients with liver disease or ALT/AST > 2.0 X ULN, serum bilirubin >2.0 X ULN - Presence of Hepatitis B surface antigen or Hepatitis C antibody test
• Patients with serum creatinine >2.0 X ULN
• Patients with WBC <3 X 109/L; Hb 90% < LLN; PLT <100 X 109/L
• Patients with active or suspected acute or chronic uncontrolled infection
• Patients who have undergone major surgery/surgical therapy within 4 weeks prior to screening
• Patients with active malignant disease within the last five years (with the exception of basal cell carcinoma or carcinoma in situ of the cervix)
• Patients with abnormal coagulation (PT and/or APTT elevated by 30% above normal limits) or patients receiving anticoagulants that affect PT (prothrombin time) or APTT (activated partial thromboplastin time)
• History of syncope or family history of idiopathic sudden death
• History of immunocompromise, including a positive HIV test result (ELISA and Western blot)
• Known hypersensitivity to somatostatin analogues or any other component of pasireotide LAR
• Patients who have a history of alcohol or drug abuse in the 6 month period prior to receiving pasireotide
• Patients who have given a blood donation (of 400 ml or more) within 2 months before receiving pasireotide
• Patients who have participated in any clinical investigation with an investigational drug within 1 month prior to dosing
• Patients with any current or prior medical condition interfering with the conduct of the study or the evaluation of the study results
• Patients with a history of non-compliance to medical regimens or who are considered potentially unreliable or will be unable to complete the entire study.
• Sexually active males unless they use a condom during intercourse while taking drug and for 3 months following last dose of pasireotide
• Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive hCG laboratory test
• Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using highly effective methods of contraception during dosing and 3 months following the last dose of pasireotide.