Cushing disease is a rare disease caused by persistent exposure to excess glucocorticoid due to abnormal secretion of adrenocorticotrophic hormone (ACTH) from a pituitary adenoma. Major clinical signs and symptoms include obesity, hypertension and cardiovascular disease, glucose intolerance, dyslipidemia, fatigue and muscle weakness, various dermatologic manifestations, neuropsychological changes, bone loss, and limited immune function. Cushing disease is associated with a decrease in quality of life (QoL) and increased mortality primarily due to cardiovascular complications. First-line treatment is surgical resection of the pituitary tumour; however, remission is not always achieved and even when it is, up to 25% of patients will experience recurrence in the long term. Despite poor evidence of efficacy and significant safety concerns, several drugs that have not been approved by Health Canada to treat Cushing disease have been used in these patients in clinical practice.
Pasireotide is a somatostatin analogue that binds with high affinity to several subtypes of somatostatin receptors that are over-expressed by ACTH-producing adenomas involved in Cushing disease. Pasireotide has a Health Canada indication for the treatment of adult patients with Cushing disease for whom surgery is not an option or for whom surgery has failed, as long as clinical benefit is derived. The maximum recommended dose is 0.9 mg twice daily. The manufacturer has requested that pasireotide be reimbursed for the treatment of patients with Cushing disease for whom medical therapy is appropriate. The objective of this report was to perform a systematic review of the beneficial and harmful effects of pasireotide for the treatment of Cushing disease in adult patients for whom surgery is not an option or for whom surgery has failed.
This review report was prepared by the Canadian Agency for Drugs and Technologies in Health (CADTH). In addition to CADTH staff, the review team included a clinical expert in endocrinology who provided input on the conduct of the review and the interpretation of findings.
Through the CADTH Common Drug Review (CDR) process, CADTH undertakes reviews of drug submissions, resubmissions, and requests for advice, and provides formulary listing recommendations to all Canadian publicly funded federal, provincial, and territorial drug plans, with the exception of Quebec.
The report contains an evidence-based clinical and/or pharmacoeconomic drug review, based on published and unpublished material, including manufacturer submissions; studies identified through independent, systematic literature searches; and patient-group submissions. In accordance with CDR Update — Issue 87, manufacturers may request that confidential information be redacted from the CDR Clinical and Pharmacoeconomic Review Reports.
The information in this report is intended to help Canadian health care decision-makers, health care professionals, health systems leaders, and policy-makers make well-informed decisions and thereby improve the quality of health care services. The information in this report should not be used as a substitute for the application of clinical judgment with respect to the care of a particular patient or other professional judgment in any decision-making process, nor is it intended to replace professional medical advice. While CADTH has taken care in the preparation of this document to ensure that its contents are accurate, complete, and up-to-date as of the date of publication, CADTH does not make any guarantee to that effect. CADTH is not responsible for the quality, currency, propriety, accuracy, or reasonableness of any statements, information, or conclusions contained in the source documentation. CADTH is not responsible for any errors or omissions or injury, loss, or damage arising from or relating to the use (or misuse) of any information, statements, or conclusions contained in or implied by the information in this document or in any of the source documentation.
This document is intended for use in the context of the Canadian health care system. Other health care systems are different; the issues and information related to the subject matter of this document may be different in other jurisdictions and, if used outside of Canada, it is at the user’s risk. This disclaimer and any questions or matters of any nature arising from or relating to the content or use (or misuse) of this document will be governed by and interpreted in accordance with the laws of the Province of Ontario and the laws of Canada applicable therein, and all proceedings shall be subject to the exclusive jurisdiction of the courts of the Province of Ontario, Canada.
CADTH takes sole responsibility for the final form and content of this document, subject to the limitations noted above. The statements and conclusions in this document are those of CADTH and not of its advisory committees and reviewers. The statements, conclusions, and views expressed herein do not necessarily represent the views of Health Canada or any Canadian provincial or territorial government. Production of this document is made possible by financial contributions from Health Canada and the governments of Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Nunavut, Ontario, Prince Edward Island, Saskatchewan, and Yukon.
