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Background <p>Somatostatin analogues (SSAs) are cornerstone treatments for hormone-secreting tumors but can disrupt glucose metabolism. Comparative effects on glycemic parameters between different SSAs and doses remain quantitatively unclear.</p> Methods <p>We searched major databases for RCTs reporting fasting blood glucose (FBG) or glycated hemoglobin (HbA1c) changes with SSA treatment vs. control/active comparator. Frequentist network meta-analysis (NMA) using Stata 17.0 compared effects across SSA types/doses (octreotide, lanreotide, pasireotide 20&#xa0;mg, 40&#xa0;mg, 60&#xa0;mg), expressed as mean differences (MDs) with 95% CIs. Treatments were ranked via surface under the cumulative ranking curve (SUCRA). Risk of bias and evidence certainty Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) were assessed.</p> Results <p>10 randomized controlled trials (RCTs) involving 973 patients with different diseases were analyzed. Pasireotide 60&#xa0;mg significantly increased FBG (MD = 1.44 mmol/L, 95% CI: 0.58 to 2.30) and HbA1c (MD = 0.60%, 95% CI: 0.29 to 0.92) versus control. Compared to octreotide and lower doses of pasireotide (20&#xa0;mg and 40&#xa0;mg), pasireotide 60&#xa0;mg also resulted in significantly worse FBG and HbA1c outcomes. Octreotide and lanreotide showed neutral glycemic effects. SUCRA ranked pasireotide 60&#xa0;mg worst for both FBG (SUCRA 10.70%) and HbA1c (SUCRA 5.50%). Results remained robust in sensitivity analyses excluding high-bias studies. GRADE certainty was high or moderate for key pasireotide 60&#xa0;mg comparisons.</p> Conclusion <p>Pasireotide 60&#xa0;mg consistently demonstrates significant adverse effects on FBG and HbA1c compared to first-generation SSAs. However, this ranking should be interpreted with caution due to asymmetric dose stratification and clinical heterogeneity.</p>

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Comparison of somatostatin analogues on glucose metabolism: A systematic review and network Meta-Analysis of randomized controlled trials

  • 期刊论文

  • 发表日期：

    2026年2月16日

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  • Ye Zhao,
  • Yunwen Tao,
  • Yewen Zhu,
  • Sicheng Li,
  • Heming Guo,
  • Yun Huang,
  • Yiting Huang,
  • Chen Fang

摘要

Background

Somatostatin analogues (SSAs) are cornerstone treatments for hormone-secreting tumors but can disrupt glucose metabolism. Comparative effects on glycemic parameters between different SSAs and doses remain quantitatively unclear.

Methods

We searched major databases for RCTs reporting fasting blood glucose (FBG) or glycated hemoglobin (HbA1c) changes with SSA treatment vs. control/active comparator. Frequentist network meta-analysis (NMA) using Stata 17.0 compared effects across SSA types/doses (octreotide, lanreotide, pasireotide 20 mg, 40 mg, 60 mg), expressed as mean differences (MDs) with 95% CIs. Treatments were ranked via surface under the cumulative ranking curve (SUCRA). Risk of bias and evidence certainty Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) were assessed.

Results

10 randomized controlled trials (RCTs) involving 973 patients with different diseases were analyzed. Pasireotide 60 mg significantly increased FBG (MD = 1.44 mmol/L, 95% CI: 0.58 to 2.30) and HbA1c (MD = 0.60%, 95% CI: 0.29 to 0.92) versus control. Compared to octreotide and lower doses of pasireotide (20 mg and 40 mg), pasireotide 60 mg also resulted in significantly worse FBG and HbA1c outcomes. Octreotide and lanreotide showed neutral glycemic effects. SUCRA ranked pasireotide 60 mg worst for both FBG (SUCRA 10.70%) and HbA1c (SUCRA 5.50%). Results remained robust in sensitivity analyses excluding high-bias studies. GRADE certainty was high or moderate for key pasireotide 60 mg comparisons.

Conclusion

Pasireotide 60 mg consistently demonstrates significant adverse effects on FBG and HbA1c compared to first-generation SSAs. However, this ranking should be interpreted with caution due to asymmetric dose stratification and clinical heterogeneity.