Octreotide Long-Acting Release is effective in preventing gastrointestinal bleeding due to angiodysplasias

Abstract

Background: Angiodysplasias are one of the most frequent causes of gastrointestinal bleeding. Pharmacological options, such as octreotide Long-Acting Release (LAR), do not yet have a defined role and are currently used for patients who are not candidates for or are refractory to endoscopic treatment. Aims: (1) To evaluate the efficacy of octreotide LAR by considering transfusion requirements (units of packed erythrocytes (UPE)/month) and number of hospitalizations/month before and during therapy; (2) to verify whether the characteristics of patients and/or concurrent medication influenced response to therapy; and (3) to evaluate the safety of therapy by registering adverse effects. Methods: A retrospective cohort of 16 patients with angiodysplasias treated with octreotide LAR was reviewed. Results: (1) There was a significant decrease (follow up before vs. follow up during) in the median number of UPE/month (1.84 vs. 0.42, p = 0.008) and the number of admissions/month (0.21 vs. 0.00, p = 0.015). (2) Of the characteristics analyzed, only the presence of aortic stenosis (vs. other comorbidities) positively influenced the response to therapy in relation to the variation in transfusion requirements (−2.39 UPE/month vs. −0.61 UPE/month; p = 0.009). (3) Adverse effects: splenic infarction (1 patient) and gallstones (1 patient).Conclusions: Octreotide LAR is effective as prophylaxis for gastrointestinal bleeding angiodysplasia by decreasing transfusion requirements and the need for hospitalizations. Patients with Octreotide LAR prevents angiodysplasia bleeding 177 aortic stenosis were those who most benefited from the therapy. A dose of 20 mg/month did not prove more effective than a dose of 10 mg/month. O octreótido Long-Acting Release é eficaz na prevenção de hemorragia por angiodisplasias gastrointestinais ResumoIntrodução: As angiodisplasias são uma das causas mais frequentes de hemorragia com ponto de partida no intestino delgado. As opções farmacológicas como o octreótido LAR não têm ainda um papel definido destinando-se a doentes não candidatos ou refratários à terapêutica endoscópica. Objetivos: (1) Avaliar a eficácia terapêutica comparando: necessidades transfusionais (unidades de concentrado eritrocitário/mês) e número de internamentos/mês antes e durante a terapêu-tica;(2) Verificar se as características dos doentes e/ou da medicação tiveram influência na resposta à terapêutica; (3) Avaliar a segurança da terapêutica (registo de efeitos adversos). Métodos: Efetuado estudo retrospetivo de coorte de 16 doentes com AD tratados com octreótido LAR. Resultados: (1) Observou-se diminuição significativa (follow up before vs follow up during) do número mediano de UCE/mês [1.84 UCE/mês vs 0,42 UCE/mês; p=0.008] e do número de internamentos/mês [0,21 internamentos/mês vs 0,00 internamentos/mês; p=0.015].(2) Das características analisadas, apenas a presença de estenose aórtica (vs outras comorbilidades) influenciou positivamente a resposta à terapêutica no que concerne à variação das necessidades transfusionais (---2,39 ...

Novel Use of Low-dose Thalidomide in Refractory Gastrointestinal Bleeding in Left Ventricular Assist Device Patients

“…It is important to note that these lesions are difficult to identify on endoscopy due to intermittent bleeding, which makes them less obvious. Certain lesions localized in the small bowel are also relatively difficult to access with conventional endoscopy (15). Thalidomide has been successfully used in patients with obscure GIB that cannot be localized.…”

Role of octreotide in small bowel bleeding

“…After a median follow-up of 78 mo, all patients showed a remarkable rise in the hemoglobin levels and a significant decrease in the number of blood transfusions, bleeding episodes, and hospitalization compared to the two years observation period before initiating the somatostatin analog[ 34 ]. In another observational study by Salgueiro et al [ 35 ], 16 patients with multiple GI vascular lesions, including angiodysplasia, were involved in the study. Among these patients, nine patients received 10 mg of long-acting repeatable (LAR) octreotide LAR per month, while the remaining received 20 mg/mo of octreotide LAR for a median time of 12 mo.…”

Efficacy and safety of pasireotide-LAR for the treatment of refractory bleeding due to gastrointestinal angiodysplasias: results of the ANGIOPAS multicenter phase II noncomparative prospective double-blinded randomized study

“…These results are in line with previous observational data indicating a decrease in bleeding and pRBC transfusion requirements in patients treated with octreotide, octreotide-LAR or lanreotide. [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] The quantity of effect observed in the ANGIOPAS study was in the range of these cases and in particular, of three series with significant transfusion requirements. 39,40,43 We did not investigate the mechanism of action of pasireotide-LAR in this study.…”

“…Several observational studies and a meta-analysis consistently suggested that somatostatin analogs could reduce rebleeding and transfusion requirements in patients with GIADs bleeding refractory or inaccessible to endoscopic therapies 24 – 44 ( Table 1 ). However, the studies testing various therapeutic schedules used an inadequate design and failed to demonstrate this putative benefit.…”