| Cushing Syndrome
Korlym vs Isturisa
Side-by-side clinical, coverage, and cost comparison for cushing syndrome.Deep comparison between: Korlym vs Isturisa with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsIsturisa has a higher rate of injection site reactions vs Korlym based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Isturisa but not Korlym, including UnitedHealthcare
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Category
Korlym
Isturisa
At A Glance
Oral
Once daily
Glucocorticoid receptor antagonist
Oral
Twice daily
CYP11B1 inhibitor
Indications
- Cushing Syndrome
- Hyperglycemia
- Cushing Syndrome
Dosing
Cushing Syndrome, Hyperglycemia Starting dose 300 mg orally once daily with a meal; titrate in 300 mg increments no more frequently than every 2-4 weeks to a maximum of 1200 mg once daily (not to exceed 20 mg/kg per day); maximum 600 mg in renal or mild-to-moderate hepatic impairment; maximum 900 mg with concomitant strong CYP3A inhibitors.
Cushing Syndrome Initiate at 2 mg orally twice daily with or without food; titrate by 1-2 mg twice daily no more frequently than every 2 weeks based on cortisol changes and tolerability; maximum 30 mg twice daily. Hepatic impairment: Child-Pugh B start at 1 mg twice daily; Child-Pugh C start at 1 mg once daily in the evening.
Contraindications
- Pregnancy
- Concomitant use of CYP3A substrates with narrow therapeutic ranges, including simvastatin, lovastatin, cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, and tacrolimus
- Concurrent systemic corticosteroids required for lifesaving purposes (e.g., immunosuppression after organ transplantation)
- History of unexplained vaginal bleeding or endometrial hyperplasia with atypia or endometrial carcinoma
- Known hypersensitivity to mifepristone or any product component
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Adverse Reactions
Most common (>=20%) nausea, fatigue, headache, decreased blood potassium, arthralgia, vomiting, peripheral edema, hypertension, dizziness, decreased appetite, endometrial hypertrophy
Postmarketing angioedema
Most common (>10%) Adrenal insufficiency, fatigue, nausea, headache, edema, nasopharyngitis, vomiting, arthralgia, back pain, rash, diarrhea, dizziness, abdominal pain, hypokalemia, myalgia, decreased appetite, hormone level abnormal, hypotension, urinary tract infection, blood testosterone increased, pyrexia, anemia, cough, hypertension, influenza
Serious Hypocortisolism, QT prolongation, adrenal hormone precursor accumulation and androgen excess, pituitary corticotroph tumor volume increase
Postmarketing Neutropenia associated with fever and infection
Pharmacology
Glucocorticoid receptor (GR-II) antagonist; mifepristone selectively blocks GR-II, antagonizing cortisol effects at the receptor level while driving compensatory increases in circulating cortisol via HPA axis feedback, and also acts as a progesterone receptor antagonist at lower doses.
Osilodrostat is a cortisol synthesis inhibitor that inhibits 11beta-hydroxylase (CYP11B1), the enzyme responsible for the final step of cortisol biosynthesis in the adrenal gland, leading to dose-dependent reductions in cortisol and increases in ACTH and cortisol precursors.
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Most Common Insurance
Anthem BCBS
Korlym
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (0/12) · Qty limit (9/12)
Isturisa
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (0/12) · Qty limit (0/12)
UnitedHealthcare
Korlym
- Covered on 4 commercial plans
- PA (1/8) · Step Therapy (0/8) · Qty limit (0/8)
Isturisa
- Covered on 4 commercial plans
- PA (6/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Korlym
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (0/3) · Qty limit (2/3)
Isturisa
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (0/3) · Qty limit (0/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
Cost estimate not availableHealthWell: Cushing's Disease or Cushing's Syndrome
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
$20/momo
R.A.R.E. Patient Support Copay Program: IsturisaCommercial or private insurance
Medicare, Medicaid, VA, TRICARE
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KorlymView full Korlym profile
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.