Acromegaly Treatment Options

Hi all,

I've been trying to understand which treatment option would suit Kabosu best.
I've started compiling a list of treatments (including just DM management) and tried to understand what is a typical life expectancy and life quality after that treatment (or if we do nothing but give him insulin).

Here's the list: https://docs.google.com/spreadsheets/d/e/2PACX-1vSJQUZAA9Sp33aoPvKJdek7JCDCInExRIGx4Q1FFBPgQ3ofncP-U8cNoCuLAcssiSkjpdxBKW9nHLGs/pubhtml

I could not find any studies that would report median survival time after cabergoline or paseriotide treatment. Are there any?

Any feedback is appreciated!

 

Thanks for putting together some of this information. I think the data on survival time after cabergoline or pasireotide might be too early to get. There have been only a small handful of cats on pasireotide because of it's cost. You might want to contact the RVC diabetes remission clinic and see if they have that data. They've been very responsive to emails. I don't know anyplace else that has pasireotide data. FWIW, the trial for pasireotide was done with drug donated by the manufacturer, it was too expensive for RVC to do the trial otherwise.

The South American group might have more data on cabergoline survival - again, it's fairly new. They are a better source of information than the small RVC trial and had a lot more cats on it. Heck, we've had many more cats here on cabergoline that RVC did, and three cats went into remission, one at the same time as the RVC trial. Also keep in mind, the goal of the RVC cabergoline trial was to find a drug that lowers IGF-1. Cabergoline does not do that, so the trial "failed". However, there was reduced insulins dose and improved quality of life, both wins for caregivers.

Some corrections, relapse is NOT common with SRT. Neko was the first cat in North America to have repeat SRT. At the time, I asked a couple of well known SRT researchers, and they knew of a total of 2 others that had relapse, but not repeat SRT. This was many years after cats had started having SRT. Many of the cats that I've seen there that have had SRT, have also passed from other conditions (such as cancer), so mean survival is impacted by that too. You might want to also differentiate SRT from other types of radiotherapy. Similarly, brain damage is very uncommon with SRT, but more likely with conventional radiotherapy. The "life quality" issues you list with SRT, resolve after about a week on pred, if they occur. They are rare, and not something I saw. I think we've seen one cat here who experienced them. There are a small percent of SRT cats who go hypothyroid and need treatment for that after SRT. SRT is also not available everywhere, not sure if you can even get it in the UK.

Relapse is also a possibility with hypophysectomy. We had one cat here, Schmee, who relapsed. Cost of surgery in the US is also over $10K. There are 2-3 places in the US that perform this surgery with experienced surgeons, as well as RVC, a place in Australia and the Netherlands. I have also heard of one case of a cat who had the surgery in the US, they didn't get all the pituitary so the caregiver had to follow on with SRT. I'd strongly recommend only getting the surgery by an experienced surgeon. At RVC the death rates at surgery have come down with time.

 

Thank you! I updated the table with what you just said.

We have been considering surgery with RVC, but it is very expensive and traveling with a sick cat in the middle of a pandemic is quite tricky. Ireland is very strict on travel these days, and veterinary reasons are considered non-essential. Brexit does not help here either: I myself need quite some paperwork to go to UK. Also, if Kabosu does not survive the surgery or the trip, I'd be blaming myself forever. He seems to be relatively OK these days despite high BG. I'm also worried he may have something else besides acro going on, which may complicate the surgery (his stools are abnormal, abdominal ultrasound showed inflammation in his small intestine, his pancreatitis tests have never come back negative and the vet mentioned heart murmur).

It's great to know that Cabergoline has improved quality of life for many kitties here! Looks like that's really the only affordable treatment. I am meeting with an endocrinologist vet tomorrow, will try to ask her whether that's something they can prescribe us.

 

For my first confirmed aero cat, MurrFee, I just controlled DM with insulin the best I could. He was up to more than 50 units insulin twice a day. At the end he would just not eat enough and kept losing weight. It helped when I added dry food. With my current aero cat, Snuffles, I opted for cabergoline (started in Dec 2020). It seems to improve quality of life but insulin dose is still increasing slowly. Looking back my first diabetic cat, Grey Ghost, may have been aero or maybe IAA. He was doing excellently and a low dose and then became resistant. Two units of R would not budge a high BG. My vet was not helpful and di not want to increase insulin dose. He was up to 22 lobs and not overweight at all.

 

GI issues are very common with acros, either IBD or small cell lymphoma or mega colon are not unsual. Heart issues also common and warrant further investigation. And might very well rule out surgery too. Good luck with the vet visit tomorrow.

 

Thanks for the info!
You've had so many cats! Wow!

Thank you.
Talked to the specialist vet. Unfortunately no treatment is available in Ireland: no SRT or any other radiation therapy for pets, no surgery, no access to paseriotide. The only treatment we could possibly get here is Cabergoline but she was advocating very strongly against it, and she thinks it does nothing. Kabosu would also need a lot of different very pricey tests (CT scan, abdominal ultrasound, heart ultrasound, bloodwork and urine culture) if we were to choose radiation or surgery abroad.

I will think a bit more whether I can arrange the travel...
She'll also ask whether Paseriotide could be ordered from abroad and what the price will be, and will check with the other endocrinologist what he thinks on cabergoline.

 

I would push very hard for cabergoline. The only side effects are some possible mild GI issues early on. There is no down side to you experimenting. Ask the vet to humour you. At the time of the RVC study on pasireotide (a few years now), it wasn't even a permitted drug in the UK. They had to get special permission to use it on a trial. And I want to emphasize the outrageously expensive part. Paying a year of that would more than cover first class to London and payment for surgery.

 

Pasireotide cost for cats:
Dose: Cats received 8 mg/kg of pasireotide LAR by subcutaneous injection before discharge and once monthly thereafter for a planned 6‐month follow‐up period
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5354018/
Assuming 7kg (about 16 lbs), monthly dose would be 42mg.
Cost of 40mg is about $15k
https://insiderx.com/drugs/signifor-lar/prices

Thus, pasireotide is not economically feasible for cats.

 

Thanks for doing the leg work on this Larry. Back in 2015 I checked into pasireotide, my vet couldn't even find where to get the LAR version much less pricing, even though it was allowed in Canada. Pricing for Neko for the daily version of Signifor (pasireotide) was I think around $5000 every 3 months for a Neko sized dose (6.5 kg), so around $20k per year. The LAR or monthly version is supposed to have better results.

 

Thank you!
Talked to our vet, she is happy to prescribe cabergoline to us!

Thank you for this info! These prices are indeed crazy! :'(

 

@Lee cuzz the link in this post above has a pretty good comparison of treatment options for acro

The IAA usually goes away on its own after about a year.

 

Thanks, I printed the info. As for IAA, it's been a year in November...

 

It's hard to say when the IAA "started" but yes you've been high dose for quite awhile now...so hopefully breaks sooner vs later. If you all of a sudden start seeing numbers dropping let Wendy know, sometimes the IAA ride down is scary. She can help with dosing.

 

It's so individual. I just treated my cat with insulin and she lived happy for several years.... Died of something completely unrelated.