Comparison of the use of Metyrapone and Osilodrostat for Cushing Disease: A Systemic Review

DOI: https://doi.org/10.46610/JAPP.2024.v06i01.002

Abstract

Introduction: Cushing disease is characterised by excessive production of adrenocorticotropic hormone (ACTH) from the anterior pituitary, which results in increased release of cortisol from the adrenal glands. Nearly 10 to 15 million people per year have been reported to have this rare disease. As of today, there are different therapies available. The chances of recurrence and severe side effects are high. Objectives: To overcome the recurrence and side effects, we compared the drugs metyrapone and osilodrostat (class 11 beta-hydroxylase inhibitors) for their safety, efficacy, and other pharmacological actions before Cushing's disease. Methodology: Nine electronic databases were searched regarding the drugs metyrapone and osilodrostat for the treatment of Cushing's disease using the keywords. A total of 14 case studies were collected, which show different results and conclusions. Results and discussion: Based on the comparison, both drugs exhibited the same mechanism of action, but administering metyrapone showed more severe side effects than osilodrostat. While osilodrostat has greater efficacy, reducing the cortisol level faster, and also, the drug osilodrostat has a prolonged half-life, allowing it to be used only twice daily compared to the drug metyrapone, which requires six times daily dosing. Conclusion: Based on this, we conclude that the drug osilodrostat has a greater advantage over the drug metyrapone and is also the best treatment option for Cushing's disease.