Comparison of octreotide LAR and lanreotide autogel as post-operative medical treatment in acromegaly

Abstract

Long-acting somatostatin analogs are frequently used as adjuvant treatment of acromegaly patients after noncurative surgery. This sudy aims to compare the efficacy of octreotide long-acting release (OCT) and lanreotide Autogel (LAN) in acromegaly patients. Sixty-eight patients not cured by transsphenoidal endoscopic or microscopic pituitary surgery between 2003 and 2009 were retrospectively analyzed (25 men; 43 women; mean age 41.1 ± 10.9 years [range 18–65 years]). The patients were assigned randomly to OCT (n = 36) and LAN (n = 32) groups. Evaluations included insulin-like growth factor I (IGF-I) and growth hormone (GH) after oral glucose tolerance test (OGTT) 3, 6, 12 and 18 months after starting medical treatment; pituitary magnetic resonance imaging was performed before treatment and after 3 and 12 months. Patients achieving IGF-I levels within the age and gender normal range and GH level <1 μg/l following OGTT were considered a ‘biochemical cure’. Mean IGF-I and GH values and tumor volumes (cm3) in the LAN and OCT groups were similar in the post-operative period before initiation of medical treatment. A statistically significant decrease in GH and IGF-I levels was obtained for both treatment groups at each follow-up visit compared to the previous value. Tumor shrinkage after 12 months of treatment was statistically significant in both groups but the percentage tumor shrinkage (28.5% vs. 34.9%, P = 0.166) and rate of patients achieving biochemical cure (63.9 and 78.1%, P = 0.454) were similar between OCT and LAN groups, respectively. OCT and LAN treatment options have similar efficacy for ensuring biochemical cure and tumor shrinkage in acromegaly patients who had noncurative surgery.

Efficacy, safety, and pharmacokinetics of sustained-release lanreotide (lanreotide Autogel) in Japanese patients with acromegaly or pituitary gigantism

“…Patients were randomly assigned and equally distributed into 60-mg, 90-mg, or 120-mg dosing groups. Treatment was administered deep subcutaneously in the buttocks at Weeks 0, 8,12,16, and 20 using the injection device available at the time of the study, which comprised a ready-to-use, prefilled syringe with either a 1.2-mm (60-mg and 90-mg doses) or 1.4-mm diameter needle (120-mg doses).…”

“…The drug is slowly released over a period of at least 1 month following administration from a depot formed at the injection site [8]. In international studies, this treatment has demonstrated good efficacy and safety in the medical management of acromegaly [9-13], with an efficacy and safety profile that is similar to that of octreotide LAR [14][15][16]. Lanreotide Autogel has been used for a number of years in clinics around the world.…”

Endoscopic endonasal transsphenoidal treatment for acromegaly: 2010 consensus criteria for remission and predictors of outcomes

“…But, there is limited published literature with new criteria for acromegaly on outcomes and factors affecting the remission rates. Patients for which biochemical remission is not achieved with initial resection are left with few options; reoperation, medical therapy and radiosurgery (32,36). Medical management and radiosurgery are costly and variably effective options.…”

An update on the treatment of acromegaly

“…Somatostatin analogs exert their maximum effect on GH levels after 3-6 months, 33 and on IGF-1 levels by 6-12 months. 34 Attempts have been made to identify patients who will exhibit a good response to somatostatin analogs. For example, it has previously been demonstrated that so-called "densely granulated" somatotroph adenomas are more likely to respond to somatostatin analogs than sparsely granulated adenomas, with long-term IGF-1 normalization rates of 52% versus 7%, respectively.…”

“…Interestingly, using the OGTT GH cutoff of ,0.4 µg/L, biochemical control with either agent decreased substantially to 27% for octreotide LAR and 31% for lanreotide ATG. 34 Notably, there was no crossover between drugs in this study, and patients who required additional therapy including a second surgery within 18 months were excluded from the final analysis.…”