Forty Month Follow-Up of Persistent and Difficultly Controlled Acromegalic Patients Treated with Depot Long Acting Somatostatin Analog Octreotide

Yetkin, Demet Özgil; Boysan, Serife Nur; Tiryakioğlu, Özay; Yalin, Ayse Serap; Kadıoğlu, Pınar

doi:10.1507/endocrj.k06-100

Cited by 15 publications

(12 citation statements)

References 28 publications

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“…The authors concluded that post-glucose GH levels are not useful for the evaluation of disease control in patients receiving SSAs. Another study found discordant serum IGF-1 and glucose-suppressed GH levels in 41% of patients receiving octreotide LAR [13]. In the current study, discordant IGF-1 and GH levels at week 24 or at early termination were observed in 11 of 49 patients who had both these values available (22.4% of patients).…”

Section: Discussionsupporting

confidence: 55%

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Effectiveness of self- or partner-administration of an extended-release aqueous-gel formulation of lanreotide in lanreotide-naïve patients with acromegaly

et al. 2009

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Surgical resection is often not curative in patients with acromegaly and long-acting somatostatin analogues (lanreotide or octreotide) are often needed. This study assessed the efficacy and safety of self- or partner-administration of lanreotide in patients with acromegaly. This was a six-month, single-arm, open-label study conducted at 13 endocrinology clinics. Fifty-nine patients received deep subcutaneous lanreotide injections every 28 days. Twelve patients started on 120 mg lanreotide and forty-seven started on 90 mg lanreotide. At week 16, the dose was adjusted to 60, 90 or 120 mg based on insulin-like growth factor-1 (IGF-1) levels at week 12. Fifty-nine patients with acromegaly either switched from long-acting octreotide (switch; n = 33) or were somatostatin analogue treatment-naïve or not currently taking long-acting octreotide (“other”; n = 26). The key endpoints included the percentage of patients/partners able to self- or partner-inject lanreotide and those with normal IGF-1 or growth hormone (GH) levels at week 24/early termination. 100% of patients/partners correctly self- (n = 41) or partner-injected (n = 18) lanreotide by week 4. By week 24/early termination, IGF-1 levels were controlled in 93.7% of switch and 46.2% of “other” patients, while GH levels were controlled in 76.9% and 39.1% of patients, respectively. Both IGF-1 and GH were controlled in 73.1% of switch and 30.4% of “other” patients. Most switch patients (81%) reported they preferred lanreotide over long-acting octreotide for future use (P = 0.0001). Self- or partner-administration of lanreotide is generally well tolerated and associated with IGF-1 and GH control in many lanreotide-naïve patients with acromegaly.

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Section: Discussionsupporting

confidence: 55%

“…Previous studies have reported discordant serum IGF-1 and GH levels in patients with acromegaly on SSA therapies [11–13]. Discordant values were commonly reported as normal IGF-1 and either high random or post-glucose GH levels, although the reverse has also been reported.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of self- or partner-administration of an extended-release aqueous-gel formulation of lanreotide in lanreotide-naïve patients with acromegaly

et al. 2009

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“…Clinical results from studies of patients with acromegaly treated with doses of octreotide LAR up to 60 mg/month show a similar safety profile to that reported with conventional treatment (20–30 mg/month) with octreotide LAR. The adverse events reported from patients in the dose-optimization studies discussed above were very similar to conventional therapy with octreotide LAR and report mild adverse events mostly involving the gastrointestinal tract [32, 36, 51, 64]. Some studies reported non-significant increases in gallstones or gallbladder sludge [32, 51, 56].…”

Section: Safety and Tolerability Of Srls Is Maintained At Higher Dosesmentioning

confidence: 95%

Clinical efficacy and safety results for dose escalation of somatostatin receptor ligands in patients with acromegaly: a literature review

Fleseriu

2010

Pituitary

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Acromegaly is a rare disease with a multifaceted clinical presentation. In 90–95% of patients with acromegaly, the disease is caused by a growth hormone (GH)-secreting pituitary adenoma with elevated GH levels that ultimately induce excessive hepatic secretion of insulin-like growth factor-1 (IGF-1). Somatostatin receptor ligands (SRLs) are considered the standard medical choice for the treatment of acromegaly, and normalization of GH and IGF-1 is attainable with effective therapy. This review aims to summarize the literature relative to SRL dose escalation therapy in patients with acromegaly. A United States National Library of Medicine PubMed search of SRL’s was conducted using the following search terms: ((((LAR) OR ATG) OR octreotide) OR lanreotide Autogel) AND acromegaly. Related articles in non peer-reviewed journals were excluded. The rationale and benefits of SRL dose optimization therapy were investigated with emphasis on describing the clinical recognition, treatment, and management of patients with acromegaly. We found that dose escalation could provide additional biochemical control of acromegaly in patients who are inadequately controlled with conventional starting doses of octreotide LAR and lanreotide Autogel®. Furthermore, patients should routinely have their GH and IGF-1 levels closely monitored and their SRL dose increased or decreased thereafter according to individual response.

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“…Few studies have reported results of GH levels measured after an OGTT during medical therapy (12)(13)(14). The utility of an OGTT for monitoring therapeutic responses in these subjects has not been determined.…”

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confidence: 99%

The Utility of Oral Glucose Tolerance Testing for Diagnosis and Assessment of Treatment Outcomes in 166 Patients with Acromegaly

Carmichael

Bonert

Mirocha

et al. 2009

The Journal of Clinical Endocrinology &Amp; Metabolism

148

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Context: GH suppression after oral glucose load ͓oral glucose tolerance test (OGTT)͔ and normal age-and gender-matched IGF-I levels reflect biochemical control of acromegaly. The OGTT is the gold standard for determining control of GH secretion at diagnosis and after surgical treatment, but the usefulness of performing an OGTT in patients treated with medical therapy has not been determined. Objective:Our objective was to assess relationships between basal GH levels (basal GH), GH responses to OGTT ͓GH nadir (GH n )͔, and IGF-I levels.Design: This was a retrospective electronic database review. Setting: This study was performed at a tertiary outpatient pituitary center.Patients: A total of 166 patients with acromegaly (79 females, 87 males) were included in the study. Four categories of testing were performed: diagnosis, postoperative assessment without medication, testing during somatostatin analog (SA) therapy, and testing during dopamine agonist (DA) therapy. Main Outcome Measures:Basal serum GH and IGF-I levels and GH levels 2 h after 75 g OGTT were measured.Results: A total of 482 simultaneous OGTT and IGF-I measurements were observed from 1985-2008. Discordant results of oral glucose tolerance testing (GH n and IGF-I) were observed 33, 48, and 18% in postoperative assessment without medication, SA, and DA categories, respectively. In the SA category, 42% of tests were discordant with normal IGF-I and nonsuppressed GH n . In contrast, 4% of tests were discordant with normal IGF-I and nonsuppressed GH in those treated with DA. No significant differences in discordance were observed when basal GH was used.Conclusions: Both basal and GH n levels are highly discordant with IGF-I levels during medical therapy with SAs. The OGTT is not useful in assessing biochemical control in these subjects.

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Forty Month Follow-Up of Persistent and Difficultly Controlled Acromegalic Patients Treated with Depot Long Acting Somatostatin Analog Octreotide

Cited by 15 publications

References 28 publications

Effectiveness of self- or partner-administration of an extended-release aqueous-gel formulation of lanreotide in lanreotide-naïve patients with acromegaly

Effectiveness of self- or partner-administration of an extended-release aqueous-gel formulation of lanreotide in lanreotide-naïve patients with acromegaly

Clinical efficacy and safety results for dose escalation of somatostatin receptor ligands in patients with acromegaly: a literature review

The Utility of Oral Glucose Tolerance Testing for Diagnosis and Assessment of Treatment Outcomes in 166 Patients with Acromegaly

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