Beneficial effect of dose escalation of Octreotide-LAR as first-line therapy in patients with acromegaly

Abstract

Objective: To evaluate the efficacy of dose escalation of Octreotide-long-acting repeatable (LAR) up to 40 mg/month we studied 56 newly diagnosed patients with acromegaly (24 women, 32 men; age 20-82 years). Design: Analytical, observational, open and prospective. Methods: Three months after LAR treatment beginning with a dose of 20 mg /q28d (every 28 days), 24 patients maintained the same dose (Group A), while 32 required a dose of 30 mg/q28d (Group B). The dose was further increased to 40 mg/q28d in 17 out of the 32 patients of Group B for another 12 months (Group C). Results: After 24 months, serum GH and IGF-I levels decreased by 93.1G8.6% (95% confidence limit (CL) 90.8-95.4%) and 62.7G13.4% (95% CL 59.1-66.3%) respectively. Control of GH and IGF-I levels was achieved in 45 patients (80.3%). Tumor shrinkage after 12 months was 49.8G23%; the relative tumor shrinkage during the second 12 months of treatment was 35.3G13.1% and overall tumor volume was 68.1G16.5% (95% CL 63.7-72.5%). Glucose tolerance impaired in eight patients (14.3%): four in Group A and four in Group C (16.7% vs 36.4%, PZ0.39).The final dose was predicted by the patient's age at diagnosis (tZK2.2; PZ0.032) and baseline tumor volume (tZ2.1; PZ0.043). Conclusion: An increase of the LAR dose up to 40 mg/q28d in patients resistant to 30 mg/q28d is followed by greater suppression of GH and IGF-I levels and tumor shrinkage without further significant impairment of glucose tolerance when compared with lower doses. These results suggest that a new dosage schedule of 40 mg every 28 days is applied in patients with acromegaly mostly of young age and with bigger tumors who are likely to be poorly responsive to standard doses of Octreotide-LAR.

Efficacy of combined octreotide and cabergoline treatment in patients with acromegaly: a retrospective clinical study and review of the literature

“…The first is to increase the dose of octreotide up to 40 mg/month because dose escalation may be effective especially in young patients with large tumors [31]. The second is to administer a combined therapy of SSAs and cabergoline as shown in the current study.…”

Akromegalia — nowe spojrzenie na pacjenta. Polskie propozycje postępowania diagnostyczno-terapeutycznego w akromegalii w świetle aktualnych doniesień

“…Lanreotide autogel is available in 60, 90 and 120 mg ampoules, for subcutaneous administration every 28 days, with a possible extension of the interval between injections to 56 days for the dose of 120 mg [9,19]. Octreotide LAR is manufactured in 10, 20 and 30 mg ampoules, for intramuscular administration every 28 days, with a possible dose increase to 40 mg every four weeks in patients for whom a 30 mg dose is inefficient [20]. The dose of somatostatin analogue should be adjusted to the clinical and laboratory effects obtained after three months of using the drug [13].…”

Effect of presurgical long-acting octreotide treatment in acromegaly patients with invasive pituitary macroadenomas: a prospective randomized study

“…A review of the literature shows that long-acting octreotide reduces GH level, tumor size, and relieves systemic symptoms [6][7][8][9]. Nevertheless long-term use of somatostatin analogs may be limited due to the cost [10], thus short-term presurgical use of long-acting octreotide may be costeffective.…”