Efficacy and tolerability of lanreotide Autogel therapy in acromegalic patients previously treated with octreotide LAR

Alexopoulou, Orsalia; Abrams, Pascale; Verhelst, Johan; Poppe, Kris; Velkeniers, Brigitte; Abs, Roger; Maiter, Dominique

doi:10.1530/eje.0.1510317

Cited by 82 publications

(83 citation statements)

References 41 publications

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“…Alexopoulou et al [18] studied 25 acromegalic patients who were switched from octreotide LAR (20–40 mg/4 weeks for at least 6 months) to lanreotide autogel, given by deep subcutaneous injection at a fixed dose of 90 mg/4 weeks. After 12 weeks, the dose of lanreotide autogel was titrated according to patients’ mean GH and IGF-1 levels at week 8.…”

Section: Overall Efficacy Of Somatostatin Analogsmentioning

confidence: 99%

Medical Treatment of Acromegaly: Comorbidities and Their Reversibility by Somatostatin Analogs

et al. 2006

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Relief of symptoms can be achieved following surgery for growth hormone (GH)-secreting adenomas, as well as after pharmacological therapy with somatostatin analogs. Recently, long-acting somatostatin analog depot formulations, octreotide LAR and lanreotide SR have become available. Somatostatin analogs control GH/insulin-like growth factor (IGF)-1 excess, induce tumor shrinkage in a high proportion of patients, improve symptoms of acromegaly with relatively limited side effects and are successfully administered in patients not suitable for surgery. Furthermore, preoperative somatostatin analogs have been suggested to improve outcome for tumors with limited invasiveness, while surgical tumor debulking in cases that are, at least partially, somatostatin resistant, increases the achievement of normal IGF-1 levels by postoperative somatostatin analog treatment. Effective control of hypertension, as well as diabetes, is mandatory in order to reduce the increased vascular morbidity/mortality. Control of GH/IGF-1 excess generally improves glucose metabolism. Somatostatin analogs improve insulin sensitivity, exerting, however, a concomitant direct inhibitory effect on insulin secretion, with a net balance leaning towards a deterioration in glucose homeostasis. As a result, oral insulin secretagogues (and/or insulin) should probably be preferred to insulin sensitizers in acromegalic patients developing diabetes while on somatostatin analogs. Nevertheless, glucose tolerance remains normal in most of the nondiabetic acromegalic patients, while diabetic acromegalic patients on insulin are at risk for hypoglycemia during initiation of somatostatin analog therapy. Although successful management of acromegaly has been associated with improvement in morphological and functional parameters of cardiomyopathy, limited and conflicting information is available regarding the effect on blood pressure control. Contradictory results have also been reported regarding sleep hypopnea or apnea in treated acromegalic patients. As acromegalic skeletal abnormalities are rather irreversible, apneic episodes may persist after normalization of hormonal levels. Aggressive therapy, including surgery, pharmacological treatment and, in some cases, pituitary irradiation, aiming at normalization of IGF-1 levels, is required for arthropathy management. Some improvement in pain, crepitus and range of motion has been observed after treatment with somatostatin analogs. Information on the impact of disease control, either by surgery or somatostatin analog treatment, on gonadal function is limited. Finally, the link between the hormonal/biochemical and the psychiatric/psychological features of acromegaly, as well as a potential basis for positive effects of somatostatin analog therapy remain unclear.

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Section: Overall Efficacy Of Somatostatin Analogsmentioning

confidence: 99%

Medical Treatment of Acromegaly: Comorbidities and Their Reversibility by Somatostatin Analogs

et al. 2006

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“…В исследовании Alexopoulou О. и соавт. у 22 отслеженных пациентов с акромегалией объем аденомы гипофиза на фоне лече-ния уменьшился по сравнению с исходным на 44% [3].…”

Section: Discussionunclassified

Autozhel' v kontrole biokhimicheskikh markerovaktivnosti akromegalii: predstavlenieklinicheskogo sluchaya

Dzeranova¹,

Giniyatullina²,

Pigarova³

et al. 2010

Obes. metabol.

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Acromegaly is a severe neuroendocrine disease that develops when the pituitary gland produces excess growth hormone (GH). Acromegaly is not only a cosmetic problem. Hypersecretion of GH leads to variety complications, decreased quality of life, shortening the expected lifespan due to development of severe cardiovascular complications. Timely diagnosis and adequate treatment can reduce mortality by 2-5 times and medical therapy deservedly plays an important role in treatment of patients with acromegaly when radical surgical treatment cannot be performed. We present a first Russian experience of acromegaly patient treatment with new preparation - Somatulin Autogel, with analysis of its favorable effects on clinical and metabolic manifestations of the disease.

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“…Two endogenous, biologically active forms of somatostatin are formed by the cleavage of prosomatostatin: SRIF-14 and SRIF-18. 27 Five different somatostatin receptor subtypes, sst [1][2][3][4][5] , have been characterized. These subtypes are 7-transmembrane domain G-protein-coupled receptors.…”

Section: Somatostatin Analogsmentioning

confidence: 99%

Pharmacological management of acromegaly: a current perspective

Manjila

Khan

et al. 2010

FOC

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Acromegaly is a chronic disorder of enhanced growth hormone (GH) secretion and elevated insulin-like growth factor–I (IGF-I) levels, the most frequent cause of which is a pituitary adenoma. Persistently elevated GH and IGF-I levels lead to substantial morbidity and mortality. Treatment goals include complete removal of the tumor causing the disease, symptomatic relief, reduction of multisystem complications, and control of local mass effect. While transsphenoidal tumor resection is considered first-line treatment of patients in whom a surgical cure can be expected, pharmacological therapy is playing an increased role in the armamentarium against acromegaly in patients unsuitable for or refusing surgery, after failure of surgical treatment (inadequate resection, cavernous sinus invasion, or transcapsular intraarachnoid invasion), or in select cases as primary treatment. Three broad drug classes are available for the treatment of acromegaly: somatostatin analogs, dopamine agonists, and GH receptor antagonists. Somatostatin analogs are considered as the first-line pharmacological treatment of acromegaly, although efficacy varies among the different formulations. Octreotide long-acting release (LAR) appears to be more efficacious than lanreotide sustained release (SR). Lanreotide Autogel (ATG) has been shown to result in similar biological control as octreotide LAR, and there may be a benefit in switching from one to the other in some cases of treatment failure. The novel multireceptor somatostatin analog pasireotide, currently in Phase II clinical trials, also shows promise in the treatment of acromegaly. Dopamine agonists have been the earliest and most widely used agents in the treatment of acromegaly but have been found to be less effective than somatostatin analogs. In this class of drugs, cabergoline has shown greater efficacy and tolerability than bromocriptine. Dopamine agonists have the advantage of oral administration, resulting in increased use in select patient groups. Selective GH receptor antagonists, such as pegvisomant, act by blocking the effects of GH, resulting in decreased IGF-I production despite persistent elevation of GH serum levels. Thus far, tumor growth has not been a concern during pegvisomant therapy. However, combination treatment with somatostatin analogs may counteract these effects. The authors discuss the latest guidelines for biochemical cure and highlight the efficacy of combination therapy. In addition, the effects of pharmacological presurgical treatment on surgical outcome are explored.

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Efficacy and tolerability of lanreotide Autogel therapy in acromegalic patients previously treated with octreotide LAR

Cited by 82 publications

References 41 publications

Medical Treatment of Acromegaly: Comorbidities and Their Reversibility by Somatostatin Analogs

Medical Treatment of Acromegaly: Comorbidities and Their Reversibility by Somatostatin Analogs

Autozhel' v kontrole biokhimicheskikh markerovaktivnosti akromegalii: predstavlenieklinicheskogo sluchaya

Pharmacological management of acromegaly: a current perspective

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