Effectiveness and tolerability of slow release lanreotide treatment in active acromegaly

Abstract

This single-center open sequential study aimed at comparing the efficacy of a 6-month treatment with lanreotide (LAN) (60-90 mg/month i.m.), to that of octreotide (OCT) (0.3-0.6 mg/day s.c.) in 45 patients with active acromegaly (GH, 63.2+/-12.1 ng/ml, IGF-I, 757+/-67.1 ng/ml). After 6 months of OCT treatment, safe GH (fasting <2.5, glucose suppressed <1 ng/ml) and IGF-I (normalized for age) levels were achieved in 23 patients. After treatment withdrawal, GH levels significantly increased in all patients, though remaining slightly lower than pre-OCT therapy (39.2+/-5.8 ng/ml) while plasma IGF-I levels were unchanged (654+/-59.4 ng/ml). After 6 months of LAN treatment, safe GH and IGF-I levels were achieved in 26 patients (57.7%). After OCT or LAN treatments, no significant difference was found between nadir GH (6+/-1 vs 5.9+/-1.1 ng/ml) and IGF-I levels (281+/-23.3 vs 262+/-20.6 ng/ml). Four out of the 20 patients poorly responsive to OCT achieved safe GH and IGF-I levels after LAN treatment. Among the 20 non-operated patients, a significant tumor shrinkage was documented by CT and/or MRI in 5 patients after OCT and in 1 patient after LAN treatment. All patients referred a notable improvement of soft tissue swelling, arthralgia, headache and weakness, both after OCT and LAN treatments. During the first days of OCT treatment, abdominal discomfort was referred by 12 patients and steatorrhea by 5 patients: side effects disappeared spontaneously in 6 cases while during treatment with pancreatic enzymes in the remaining ones. After the first injections of LAN, abdominal discomfort was referred by 10 patients and steatorrhea by 2 of them. No difference in the prevalence of both early and late side effects was noted after treatment with OCT and LAN (chi2, 0.49). The majority of these poorly tolerant patients had side effects with both compounds. During LAN treatment, side effects were mild and spontaneously disappeared but recurred after the injection of the drug in six patients. Gallstones were detected in one patient during OCT and in another during LAN, sludge was noted in 6 patients after OCT and in 2 after LAN treatment. In conclusion, the treatment with LAN allowed to achieve safe GH and IGF-I levels in 57.7% of acromegalics with an excellent patients' compliance. LAN treatment possessed similar efficacy and caused side effects with a similar incidence of OCT treatment. The recurrence of side effects after LAN injection suggests the necessity of a careful monitoring of adverse reactions.

Slow-release lanreotide in the treatment of acromegaly: a study in 66 patients

“…Although inadequate use of each drug may have allocated patients wrongly in the category of nonresponder, a difference in responsiveness to each drug seems a more likely explanation. In agreement with our observation, Colao et al (24) described recently 4 patients not normalized with octreotide but responding to lanreotide SR. Switching patients from one somatostatin analog to another might therefore occasionally be effective if patients are initially insuf®ciently controlled.…”

“…Although not proven by a randomised double blind clinical trial, these data strongly suggest that both drugs are equally effective. Moreover, both on an anamestic base (22, our data) and in sequential therapy (24), subcutaneous octreotide and lanreotide SR have been found to be equally effective in the same patients. One study showed that subcutaneous octreotide was able to induce an earlier reduction in IGF-I levels and a more marked reduction in GH levels compared with lanreotide, but after six months of therapy the effect was similar with both drugs (26).…”

Stereotactic radiosurgery for hypersecreting pituitary tumors: part of a multimodality approach

“…1,[12][13][14]22,46 Somatostatin analogs provide a more effective treatment option and can normalize IGF-I levels in 50 to 60% of patients. 3,8,9,11,24,36 The more recently introduced GH receptor antagonists appear to have encouraging prospects.…”

Complete disappearance of a GH-secreting pituitary macroadenoma in a patient with acromegaly: effect of treatment with lanreotide Autogel and consequence of treatment withdrawal

“…These data on lanreotide are in line with the demonstration that first-line SA therapy is able to improve clinical conditions and surgical outcome (15,16), induce a better biochemical disease control, and reduce the duration of hospitalization after surgery and the prevalence of secondary hypopituitarism (32). As shown in Table 2, previous studies have shown that octreotide long-acting release (LAR) and lanreotide, both as slow-release (SR) and ATG formulations, are very effective in inducing hormone control and tumor shrinkage in acromegalic patients, reporting a reduction in tumor mass rate of 31.1-82% (7,8,(17)(18)(19)(20)(21)(22)(23)(24)(25). Particularly, in the review by Bevan et al (8), tumor shrinkage was found in 51% of patients receiving SA as first-line treatment and in 27% of patients treated after unsuccessful surgery and/or radiotherapy.…”