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Pasireotide-LAR is recommended as a second-line treatment for patients with acromegaly. Although the effects of pasireotide-LAR have been well characterized in clinical studies, real-practice evidence is scant, especially in the long term and within the individualization of therapy in patients with comorbidities. To provide additional insight on the individualized approach to acromegaly management, six clinical cases of complex acromegaly treated with pasireotide-LAR for more than 5 years were reported. Pasireotide-LAR allowed the normalization of insulin-like growth factor 1 (IGF1) values in all patients and reduced tumour residue volume where present. A good safety profile and long-term tolerability were also reported., Competing Interests: Disclosure and potential conflicts of interest: AM: competing interests with Bayer, EISAI, Eli Lilly, Recordati Rase Diseases. All Authors served as Advisors for Recordati Rase Diseases. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2024/04/dic.2024-1-2-COI.pdf, (Copyright © 2024 Chiloiro S, Appetecchia M, Bianchi A, Costa D, De Acetis C, Gargiulo P, Giampietro A, Isidori AM, Jaffrain-Rea M-L, Passeri M, Pigliaru F, Poggi M, De Marinis L.)