Maria Fleseriu1, James W Findling, Christian A Koch, Sven-Martin Schlaffer, Michael Buchfelder, Coleman Gross. 1. Oregon Health & Science University (M.F.), Portland, Oregon 97239; Medical College of Wisconsin (J.W.F.), Milwaukee, Wisconsin 53051; University of Mississippi Medical Center (C.A.K.), Jackson, Mississippi 39216; University of Erlangen-Nürnberg (S.-M.S., M.B.), 91054 Erlangen, Germany; and Corcept Therapeutics (C.G.), Menlo Park, California 94025.
Abstract
CONTEXT: Pituitary effects of long-term therapy with mifepristone, a glucocorticoid receptor antagonist, in Cushing's disease (CD) patients are not well understood. OBJECTIVE: Our objective was to report changes in ACTH and pituitary magnetic resonance imaging (MRI) findings during long-term use of mifepristone in CD patients. DESIGN AND SETTING: The Study of the Efficacy and Safety of Mifepristone in the Treatment of Endogenous Cushing's Syndrome (SEISMIC) was a 24-week, open-label study of mifepristone, and its long-term extension (LTE) is a multicenter U.S. study. PATIENTS: Forty-three CD patients (mean age 45.3 years) were enrolled in SEISMIC with 27 continuing into the LTE study. INTERVENTIONS: Mifepristone (300-1200 mg) was administered once daily. MAIN OUTCOME MEASURES: ACTH and pituitary MRI were assessed at baseline and at regular intervals during treatment. RESULTS: A ≥2-fold increase in ACTH was observed in 72% of patients treated for a median duration of 11.3 months. The mean peak increase in ACTH was 2.76 ± 1.65-fold during SEISMIC, and mean ACTH concentrations remained stable during the LTE. ACTH was directly correlated with mifepristone dose and declined to near baseline levels after mifepristone discontinuation. Tumor regressed in 2 patients and progressed in 3 patients with macroadenomas. An additional microadenoma was identified after 25 months of treatment after a baseline tumor-negative MRI. CONCLUSIONS: In the largest prospective study to date, long-term mifepristone treatment increased ACTH in approximately two-thirds of patients with CD. ACTH elevations were observed within the first few weeks of treatment, were dose-dependent, and generally remained stable over time. Corticotroph tumor progression and regression may occur over time, but patients may have significant increases in ACTH levels without evidence of tumor growth.
CONTEXT: Pituitary effects of long-term therapy with mifepristone, a glucocorticoid receptor antagonist, in Cushing's disease (CD) patients are not well understood. OBJECTIVE: Our objective was to report changes in ACTH and pituitary magnetic resonance imaging (MRI) findings during long-term use of mifepristone in CDpatients. DESIGN AND SETTING: The Study of the Efficacy and Safety of Mifepristone in the Treatment of Endogenous Cushing's Syndrome (SEISMIC) was a 24-week, open-label study of mifepristone, and its long-term extension (LTE) is a multicenter U.S. study. PATIENTS: Forty-three CDpatients (mean age 45.3 years) were enrolled in SEISMIC with 27 continuing into the LTE study. INTERVENTIONS:Mifepristone (300-1200 mg) was administered once daily. MAIN OUTCOME MEASURES: ACTH and pituitary MRI were assessed at baseline and at regular intervals during treatment. RESULTS: A ≥2-fold increase in ACTH was observed in 72% of patients treated for a median duration of 11.3 months. The mean peak increase in ACTH was 2.76 ± 1.65-fold during SEISMIC, and mean ACTH concentrations remained stable during the LTE. ACTH was directly correlated with mifepristone dose and declined to near baseline levels after mifepristone discontinuation. Tumor regressed in 2 patients and progressed in 3 patients with macroadenomas. An additional microadenoma was identified after 25 months of treatment after a baseline tumor-negative MRI. CONCLUSIONS: In the largest prospective study to date, long-term mifepristone treatment increased ACTH in approximately two-thirds of patients with CD. ACTH elevations were observed within the first few weeks of treatment, were dose-dependent, and generally remained stable over time. Corticotroph tumor progression and regression may occur over time, but patients may have significant increases in ACTH levels without evidence of tumor growth.
Authors: Ellen E Lee; Lynnette K Nieman; Pedro E Martinez; Veronica L Harsh; David R Rubinow; Peter J Schmidt Journal: J Clin Endocrinol Metab Date: 2012-03-30 Impact factor: 5.958
Authors: Jana Phillips; Honey E East; Sarah E French; Eugen Melcescu; Robert D Hamilton; William C Nicholas; Jonathan F Fratkin; Andrew D Parent; Gustavo Luzardo; Christian A Koch Journal: Hormones (Athens) Date: 2012 Oct-Dec Impact factor: 2.885
Authors: Maria Fleseriu; Mark E Molitch; Coleman Gross; David E Schteingart; T Brooks Vaughan; Beverly M K Biller Journal: Endocr Pract Date: 2013 Mar-Apr Impact factor: 3.443
Authors: Cédric Fontaine-Sylvestre; Laurent Létourneau-Guillon; Robert A Moumdjian; France Berthelet; André Lacroix Journal: Pituitary Date: 2020-10-19 Impact factor: 4.107
Authors: Maria Fleseriu; Richard Auchus; Irina Bancos; Anat Ben-Shlomo; Jerome Bertherat; Nienke R Biermasz; Cesar L Boguszewski; Marcello D Bronstein; Michael Buchfelder; John D Carmichael; Felipe F Casanueva; Frederic Castinetti; Philippe Chanson; James Findling; Mônica Gadelha; Eliza B Geer; Andrea Giustina; Ashley Grossman; Mark Gurnell; Ken Ho; Adriana G Ioachimescu; Ursula B Kaiser; Niki Karavitaki; Laurence Katznelson; Daniel F Kelly; André Lacroix; Ann McCormack; Shlomo Melmed; Mark Molitch; Pietro Mortini; John Newell-Price; Lynnette Nieman; Alberto M Pereira; Stephan Petersenn; Rosario Pivonello; Hershel Raff; Martin Reincke; Roberto Salvatori; Carla Scaroni; Ilan Shimon; Constantine A Stratakis; Brooke Swearingen; Antoine Tabarin; Yutaka Takahashi; Marily Theodoropoulou; Stylianos Tsagarakis; Elena Valassi; Elena V Varlamov; Greisa Vila; John Wass; Susan M Webb; Maria C Zatelli; Beverly M K Biller Journal: Lancet Diabetes Endocrinol Date: 2021-10-20 Impact factor: 32.069
Authors: Lynnette K Nieman; Beverly M K Biller; James W Findling; M Hassan Murad; John Newell-Price; Martin O Savage; Antoine Tabarin Journal: J Clin Endocrinol Metab Date: 2015-07-29 Impact factor: 5.958