Discontinuation of somatostatin analogs while acromegaly is in long-term remission

Hatipoğlu, Esra; Bozcan, Selma; Kadıoğlu, Pınar

doi:10.1007/s11102-014-0608-3

Cited by 14 publications

(21 citation statements)

References 17 publications

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“…This is in marked contrast with our study, where only 2 of 58 patients (3.4%) had been on similarly long dose intervals, and also in contrast with the other three studies, where such dose intervals were used in 10-11% of patients [12,14] or were not used at all [13] . In addition, the inclusion of patients using cabergoline in combination with SAs in one of those studies seems inappropriate to characterize remission after SA withdrawal [13] .…”

Section: Discussioncontrasting

confidence: 97%

“…These figures are lower than the 18.5-20% remission rates found in three other studies [12][13][14] and much lower than the 42% reported in one single report [15] , but these percentage rates are derived from proportions (5/27, 4/20, 3/16, and 5/12, respectively) obtained from smaller sample sizes than in our study. In addition, these figures should not be compared without carefully analyzing differences in inclusion and remission criteria between studies.…”

Section: Discussioncontrasting

confidence: 87%

“…Nonetheless, patients achieving short-term remission have been reported to have lower GH and/or IGF-1 levels during treatment [12][13][14] . Although we were not able to identify a predictive factor for long-term remission in our study, patients with lower IGF-1 levels (<2.4 × ULN) before the introduction of octreotide LAR treatment showed a better probability of remission in the short term.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent meta-analysis, remission rates of 16 and 21% have been found for macroand microprolactinomas, respectively [11] . More recently, in acromegaly, long-term hormonal remission has been reported in 18-42% of patients after SA treatment withdrawal [12][13][14][15] . Those studies, however, included a relatively small number of patients with diverse inclusion and remission criteria.…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Remission of Acromegaly after Octreotide Withdrawal Is an Uncommon and Frequently Unsustainable Event

Casagrande

Bronstein²,

Jallad³

et al. 2016

Neuroendocrinology

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Background: Long-term remission of acromegaly after somatostatin analog withdrawal has been reported in 18-42% of patients in studies with a relatively small number of patients using different inclusion and remission criteria. The objectives of this study were to establish the probability and predictive factors for short- and long-term remission [normal IGF-1 for age/sex: IGF-1 ≤1.00 × upper limit of normal (ULN)] after octreotide long-acting release (LAR) withdrawal in a larger population of well-controlled patients with acromegaly (normal mean IGF-1 in the last 24 months). Methods: This is a prospective multicenter study in which 58 well-controlled patients with acromegaly receiving only octreotide LAR as a primary or postsurgical treatment were included in 14 university centers in Brazil. All patients had been on stable doses and dose intervals of octreotide LAR in the last year, and none had been submitted to radiotherapy. The main outcome measure was serum IGF-1 after 8 weeks (short-term) and 60 weeks (long-term) of octreotide LAR withdrawal. Results: Seventeen of 58 patients (29%) were in remission in the short term, and only 4 patients achieved long-term remission after treatment withdrawal. The Kaplan-Meier estimated remission probability at 60 weeks was 7% and decreased to 5% at 72 weeks. The short-term remission rate was significantly higher (44%; p = 0.017) in patients with pretreatment IGF-1 <2.4 × ULN. No other predictive factor for short- or long-term remission was found. Conclusion: Our results show that long-term remission of acromegaly after octreotide LAR withdrawal was an uncommon and frequently unsustainable event and do not support the recommendation of a systematic withdrawal of treatment in controlled patients.

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Section: Discussioncontrasting

confidence: 97%

Section: Discussioncontrasting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-Term Remission of Acromegaly after Octreotide Withdrawal Is an Uncommon and Frequently Unsustainable Event

Casagrande

Bronstein²,

Jallad³

et al. 2016

Neuroendocrinology

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“…Most studies have found that the disease is likely to recur soon after discontinuation, although some studies have found that GH and IGF1 levels remain at safe levels in a small subset of patients even after treatment discontinuation (4, 9, 10, 11). Based on the limited data currently available (mostly case reports/series), it appears that remission after discontinuation of medical treatment may be more likely in patients with low GH and IGF1 levels before treatment withdrawal, in those who respond well to low-dose treatment, in patients without adenoma on magnetic resonance imaging (MRI) and/or in patients receiving prolonged treatment (3, 12, 13, 14). Nonetheless, the characteristics of patients likely to achieve sustained remission after treatment discontinuation are still not well understood.…”

Section: Introductionmentioning

confidence: 99%

Active postoperative acromegaly: sustained remission after discontinuation of somatostatin analogues

Álvarez-Escolá

Cárdenas-Salas

2016

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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SummaryIn patients with active acromegaly after pituitary surgery, somatostatin analogues are effective in controlling the disease and can even be curative in some cases. After treatment discontinuation, the likelihood of disease recurrence is high. However, a small subset of patients remains symptom-free after discontinuation, with normalized growth hormone (GH) and insulin-like growth factor (IGF1) levels. The characteristics of patients most likely to achieve sustained remission after treatment discontinuation are not well understood, although limited evidence suggests that sustained remission is more likely in patients with lower GH and IGF1 levels before treatment withdrawal, in those who respond well to low-dose treatment, in those without evidence of adenoma on an MRI scan and/or in patients who receive long-term treatment. In this report, we describe the case of a 56-year-old female patient treated with lanreotide Autogel for 11 years. Treatment was successfully discontinued, and the patient is currently disease-free on all relevant parameters (clinical, biochemical and tumour status). The successful outcome in this case adds to the small body of literature suggesting that some well-selected patients who receive long-term treatment with somatostatin analogues may achieve sustained remission.Learning points:The probability of disease recurrence is high after discontinuation of treatment with somatostatin analogues.Current data indicate that remission after treatment discontinuation may be more likely in patients with low GH and IGF1 levels before treatment withdrawal, in those who respond well to low-dose treatment, in those without evidence of adenoma on MRI, and/or in patients receiving prolonged treatment.This case report suggests that prolonged treatment with somatostatin analogues can be curative in carefully selected patients.

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Physiopathology, Diagnosis, and Treatment of GH Hypersecretion

Kasuki

Dalmolin

2017

Endocrinology

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Discontinuation of somatostatin analogs while acromegaly is in long-term remission

Abstract: The final GH levels prior to discontinuation of SRL should be taken into consideration in patients with acromegaly in long-term remission. Moreover, the first visit 3 months after withdrawal is critically important for determining the future status of remission.

Cited by 14 publications

References 17 publications

Long-Term Remission of Acromegaly after Octreotide Withdrawal Is an Uncommon and Frequently Unsustainable Event

Long-Term Remission of Acromegaly after Octreotide Withdrawal Is an Uncommon and Frequently Unsustainable Event

Active postoperative acromegaly: sustained remission after discontinuation of somatostatin analogues

Physiopathology, Diagnosis, and Treatment of GH Hypersecretion

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