SAT-121 - Comparative Efficacy and Safety of Oral vs Injectable Medical Therapies for Acromegaly: A Systematic Review and Network Meta-Analysis

Introduction
Acromegaly is a chronic endocrine disorder requiring sustained biochemical control to reduce morbidity and mortality. Multiple therapies are available, including injectable and oral formulations, with varying efficacy and tolerability. Recently, the U.S. FDA approved paltusotine (Palsonify) as the first once-daily oral treatment for adults with acromegaly, expanding non-injectable options.
Methods
We searched randomized controlled trials of medical therapies for acromegaly and conducted a network meta-analysis, with risk of bias assessed using ROB 2.0.
Result
A total of 37 studies comprising 9,368 patients were included in the network meta-analysis, with an additional randomized controlled trial evaluating paltusotine (n = 58). Among injectable therapies, pasireotide demonstrated superior biochemical control compared with octreotide (OR 3.21; 95% CI 1.54–6.70) and greater GH suppression (MD −0.55; 95% CI −0.90 to −0.20). Pegvisomant also showed higher efficacy for IGF-1 normalization versus octreotide (OR 2.50; 95% CI 1.20–5.20). Oral paltusotine was non-inferior to injectable SRLs for maintaining IGF-1 control (OR 0.94; 95% CI 0.45–1.98) with minimal change in IGF-1 levels (MD 0.02; 95% CI −0.08 to 0.12). SUCRA rankings favored Pasireotide, paltusotine, pegvisomant for efficacy, while oral octreotide ranked highest for safety and patient preference, reflecting reduced injection-site reactions and improved treatment acceptability.
Conclusion
This network meta-analysis demonstrates that while pasireotide and pegvisomant provide the highest efficacy, paltusotine emerges as the most effective oral therapy, offering a favorable balance of biochemical control, safety, and patient acceptability.

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