IGF1 and acromegaly: The second study, the phase III CHIASMA OPTIMAL study, randomized 56 patients with active acromegaly on stable iSRL for at least 3 months and IGF-I <1.0 x ULN to either OOC or placebo for 36 weeks.30 The initial OOC dose was 20 mg twice daily and titrated to a maximum dose of 40 mg twice daily based on symptoms and to maintain IGF-I levels <1.0 ULN.