Novel Platform for Predicting Drug Effects in Patients with Acromegaly: Translational Exposure-Response Evaluation of Growth Hormone–Inhibitory Effect of Octreotide after Growth Hormone–Releasing Hormone Stimulation

Abstract

Acromegaly is a chronic systemic disease characterized by facial and peripheral changes caused by soft tissue overgrowth, together with multiple complications. Despite available surgical and medical therapies, suitable treatments for acromegaly are still lacking.Efficient drug development requires an understanding of the exposure-response (E-R) relationship based on non-clinical and early clinical studies. We aimed to establish a platform to facilitate the development of novel drugs to treat acromegaly. We evaluated the E-R relationship of the growth hormone (GH)-inhibitory effect of the somatostatin analogue, octreotide, under growth hormone-releasing hormone (GHRH) + arginine stimulation in healthy participants and compared the results with historical data for patients with acromegaly. This randomized five-way crossover study included two placebo and three active-treatment periods with different doses of octreotide acetate. GH secretion in the two placebo periods was comparable, confirming the reproducibility of the response with no carryover effect. GH secretion was inhibited by low-, medium-, and high-dose octreotide acetate, in a dose-dependent manner. We also examined the E-R relationship in monkeys as a preclinical drug evaluation study and in rats as a more convenient and simple system for screening candidate drugs. The E-R relationships and EC50 values were similar among animals, healthy participants and patients with acromegaly, which suggests that GH stimulation studies in early research and development stages allowed simulation of the drug responses in patients with acromegaly.