Pasireotide (Signifor)
Overview
A multireceptor-targeted somatostatin analog with high binding affinity for SSTR1, SSTR2, SSTR3, and SSTR5, particularly notable for its 40-fold greater affinity for SSTR5 compared to octreotide. This receptor profile makes pasireotide uniquely effective in Cushing's disease, where corticotroph adenomas predominantly express SSTR5. Pasireotide suppresses ACTH secretion from pituitary corticotroph tumors, reducing cortisol production.
Key Research Findings
FDA-approved for Cushing's disease (2012) and acromegaly (LAR formulation, 2014). Phase III trial in Cushing's disease demonstrated normalization of urinary free cortisol in 26% of patients at 6 months (Colao et al., NEJM, 2012). Superior efficacy to octreotide LAR in acromegaly patients not controlled on first-generation somatostatin analogs. Hyperglycemia is the most significant side effect due to SSTR5-mediated insulin suppression.
Subcutaneous injection (twice daily), Intramuscular injection (monthly LAR)
FDA Approved
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Find a Pasireotide (Signifor) ProviderRelated Peptides
Octreotide (Sandostatin)
FDA ApprovedA synthetic octapeptide analog of somatostatin with a substantially longer half-life (90 minutes IV, 6 hours subcutaneous vs. 2 minutes for native somatostatin). Octreotide binds somatostatin receptors (primarily SSTR2 and SSTR5) to inhibit the secretion of GH, glucagon, insulin, gastrin, secretin, VIP, and other GI hormones. It reduces splanchnic blood flow, GI motility, and exocrine pancreatic secretion.
Lanreotide (Somatuline Depot)
FDA ApprovedA synthetic octapeptide analog of somatostatin with high affinity for SSTR2 and moderate affinity for SSTR5 receptors. Lanreotide is formulated as a supersaturated solution that forms a drug depot at the injection site, providing sustained release over 4 weeks. It inhibits GH secretion, GI hormone release, and has direct antiproliferative effects on neuroendocrine tumor cells through cell cycle arrest and apoptosis induction.
Plecanatide (Trulance)
FDA ApprovedA synthetic 16-amino acid peptide structurally related to uroguanylin, an endogenous intestinal peptide that regulates fluid and electrolyte homeostasis in the GI tract. Plecanatide activates guanylate cyclase-C (GC-C) receptors on intestinal epithelial cells in a pH-dependent manner, preferentially in the proximal small intestine where pH is slightly acidic. GC-C activation increases intracellular and extracellular cGMP, stimulating chloride and bicarbonate secretion while reducing visceral pain signaling.
Linaclotide (Linzess)
FDA ApprovedA synthetic 14-amino acid peptide structurally related to the heat-stable enterotoxin of Escherichia coli and the endogenous peptide guanylin. Linaclotide activates guanylate cyclase-C (GC-C) on the luminal surface of intestinal epithelium, increasing intracellular cGMP to stimulate CFTR-mediated chloride and bicarbonate secretion, accelerating intestinal transit. Extracellular cGMP also reduces firing of visceral afferent pain fibers, providing analgesic effects in the gut.