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

Abstract

Objective: Slow-release (SR) lanreotide is a long-acting somatostatin analog that has been developed in order to overcome the inconvenience of multiple daily subcutaneous injections of octreotide, required for metabolic control in acromegaly. Lanreotide SR has been found to be well tolerated and effective in reducing GH and IGF-I levels but clinical data are still limited compared with those with subcutaneous octreotide treatment. Design: Sixty-six unselected patients with active acromegaly were therefore evaluated in a multi-center, prospective, open label study. Lanreotide SR was given at a dose of 30 mg intramuscular every 7±14 days. Methods: At baseline and after 2, 4, 8, 12, 24, 36 and 48 weeks patients underwent a clinical examination with assessment of acromegaly related symptoms, and blood was sampled for serum GH, IGF-I, prolactin, glycosylated hemoglobin, fasting glucose, hematology, kidney function and liver function tests. Biliary ultrasonography and pituitary magnetic resonance imaging were performed at baseline and after one year.

Clinical use of cabergoline as primary and adjunctive treatment for acromegaly

“…Three medical options exist: dopamine agonists (DAs), somatostatin analogues, and pegvisomant. Somatostatin analogues result in normalisation of GH secretion and IGF1 production in 45-65% of patients (10,11) but require a parenteral route of administration and may be associated with adverse effects including local inflammation, gastrointestinal symptoms and cholelithiasis. Pegvisomant, a GH receptor antagonist, is very effective, with normalisation of IGF1 in 97% of patients (12,13) but its use is limited by cost, availability and the requirement for daily s.c. injections.…”

Somatostatin agonists for treatment of acromegaly

“…a Frequencies are adopted from: octreotide LAR: http://www.rxlist.com according to manufacturer reports Cozzi et al, 2003;Davies et al, 1998;Flogstad et al, 1997;Jallad et al, 2005;Lancranjan and Atkinson, 1999;Lancranjan et al, 1996;Stewart et al, 1995); lanreotide autogel: Caron et al, 2002Caron et al, , 2006Lucas and Astorga, 2006); lanreotide SR: Attanasio et al, 2003;Caron et al, 1997;Chanson et al, 2000a,b;Giusti et al, 1996;Gutt et al, 2005;Lucas et al, 2003;Marek et al, 1994;Morange et al, 1994;Verhelst et al, 2000).…”

Optimalization and cost management of lanreotide-Autogel therapy in acromegaly

“…Somatostatin analogs such as octreotide and lanreotide are acceptable therapeutic options in acromegaly since they are known to normalize IGF-I and GH levels in 40-60% and to induce some tumor shrinkage in 30% of subjects (10,11). These drugs are available in depot preparations in different dosages, 20-30 mg for octreotide-LAR and 60-90-120 mg for lanreotide-Autogel.…”

“…Cabergoline, a long-acting dopamine agonist, appears to have a particular benefit in acromegalic patients with moderate disease activity or a tumor co-secreting prolactin (8,9). Long-acting somatostatin analogs, such as octreotide and lanreotide, exhibiting a high affinity for somatostatin analog long acting (SSTR)-2, have been shown to be effective, normalizing serum IGF-I levels in up to 60% of unselected cases (10)(11)(12)(13)(14)(15)(16). The GH receptor antagonist, pegvisomant, is presently the most effective medical treatment, normalizing IGF-I secretion in about 90% of cases (17).…”