Optimal dosage interval for depot somatostatin analogue therapy in acromegaly requires individual titration

Jenkins, Paul J.; Akker, Scott; Chew, Samuel Teong Huang; Besser, G. M.; Monson, John P.; Grossman, Ashley

doi:10.1046/j.1365-2265.2000.01168.x

Cited by 46 publications

(31 citation statements)

References 26 publications

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“…More recently, a large number of acromegalic subjects switched from lanreotide prolonged release to lanreotide-Autogel could remain well controlled with injections every 6 or even 8 weeks, at the condition that they were well controlled by lanreotide prolonged release every 10-14 days (24). The possibility of extending the interval between injections from once every 4 to once every 6 weeks or even longer without loosing efficacy has also been reported with octreotide-LAR (22,25,26). After a total of 12 months of treatment with lanreotide-Autogel, a true steady state was still not clearly obtained in some of our patients.…”

Section: Discussionmentioning

confidence: 70%

“…In one study, it was shown that 27% of patients with acromegaly still had safe GH levels 3 weeks after their last injection, suggesting that the interval may be increased from once every 1 or 2 weeks to once every 3 weeks when subjects initially respond well (22). In another study, the interval between injections could even be increased to once every 4 weeks in lanreotidesensitive subjects, without altering the efficacy upon IGF-I and GH secretion (23).…”

Section: Discussionmentioning

confidence: 99%

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Optimalization and cost management of lanreotide-Autogel therapy in acromegaly

Abrams

Alexopoulou

Abs

et al. 2007

European Journal of Endocrinology

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Optimalization and cost management of lanreotide-Autogel therapy in acromegaly

Abrams

Alexopoulou

Abs

et al. 2007

European Journal of Endocrinology

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“…This dose can then be titrated depending on the response of GH and IGF-I. In some patients, the effect of LAR may be prolonged, allowing for lengthening of the dosing interval [21].…”

Section: Dosage/administrationmentioning

confidence: 99%

Medical therapy: Options and uses

Carmichael

Bonert

2007

Rev Endocr Metab Disord

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Since the initial use of medical treatment for acromegaly, several advances have been made in the understanding of the pathophysiology of growth hormone producing tumors, resulting in the development of multiple medical options and novel treatments. Currently there are three major classes of medication available for the treatment of acromegaly: somatostatin receptor ligands, growth hormone receptor antagonists, and dopamine agonists. Somatostatin receptor ligands are the treatment of choice for acromegaly due to their effectiveness in controlling growth hormone excess in approximately 60% of patients and their beneficial effects on tumor volume. Clinical trials have demonstrated efficacy of pegvisomant in up to 97% of patients, but long term data and safety have yet to be established. Dopamine agonists are inexpensive, but their use is hampered by their lack of efficacy compared to other medications. Medical therapy has an established role as adjuvant therapy after non-curative surgery, as well as primary therapy for selected patients unsuitable for surgical resection. Medical treatment to control growth hormone hypersecretion is often needed after radiation therapy until the effects are evident. Preliminary data suggest a potential role for medical treatment prior to surgical resection, surgical debulking to improve medical efficacy, and combination therapy with multiple medications from the three classes. More studies are required, however, to validate the utility of these approaches in treating acromegaly. With the available therapies, disease control can be achieved in nearly all patients with acromegaly.

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“…Patient convenience and compliance are further improved by careful dose titration [19]. Whether these formulations also result in tumour shrinkage and how this might compare with that observed with subcutaneous octreotide has been uncertain.…”

Section: Discussionmentioning

confidence: 99%

Predicting Therapeutic Response and Degree of Pituitary Tumour Shrinkage during Treatment of Acromegaly with Octreotide LAR

Jenkins¹,

Emery²,

Howling

et al. 2004

Horm Res Paediatr

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Background/Aims: The efficacy of transsphenoidal surgery in the treatment of patients with acromegaly is largely dependent on tumour size. A reduction in pituitary tumour volume by medical therapy might therefore improve subsequent surgical cure rates. This study prospectively determined the effects of the depot somatostatin analogue octreotide LAR on pituitary tumour size, GH and IGF-I levels and clinical symptoms in a cohort of previously untreated patients with acromegaly. Methods: Six patients newly diagnosed with acromegaly (mean age 53 years; range 42–76 years) received intramuscular octreotide LAR every 28 days for 6 months. The initial dose of LAR was 20 mg, but increased to 30 mg after the initial 3 injections if mean GH levels were >5 mU/l. Prior to commencing LAR therapy, each patient received 3 injections of subcutaneous octreotide (50, 100 and 200 µg) in a randomized order on separate days, and the serum GH response was measured. Pituitary tumour volume was calculated from MRI or computed tomography scans at baseline, then 3 and 6 months after initiation of treatment, and assessed by a ‘blinded’ radiologist in random order. At baseline, 4 patients had a macroadenoma and 2 patients had a microadenoma. For the latter, the whole gland volume was measured. Results: Serum GH levels decreased from 29.6 ± 19.2 mU/l (mean ± SD) at baseline to 12.1 ± 10.5 mU/l at 3 months and 10.4 ± 9.3 mU/l at 6 months. Three patients achieved a mean serum GH level of <5 mU/l. In these patients, the serum GH had declined to <5 mU/l in response to a single 100 µg subcutaneous octreotide injection. Serum IGF-I levels decreased by a mean of 45 ± 7.4%. Tumour volume decreased in all patients: mean baseline volume 2,175 mm³ (range 660–6,998) decreasing to 1,567 mm³ (range 360–4,522) at 3 months (p < 0.05) and 1,293 mm³ (range 280–4,104) at 6 months (p < 0.002). The mean percentage decrease in size was 29% (range –54 to +4%) at 3 months (p < 0.02) and 47% (range 21–97%) at 6 months (p < 0.002). There was no statistically significant correlation between GH response and tumour shrinkage. Conclusions: A single test dose of subcutaneous octreotide may be useful in predicting the subsequent efficacy of octreotide LAR. Octreotide LAR results in significant shrinkage of pituitary tumours of newly diagnosed patients with acromegaly. Whether its administration to such patients for 6–12 months can improve the efficacy of subsequent transsphenoidal surgery will require further study.

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Optimal dosage interval for depot somatostatin analogue therapy in acromegaly requires individual titration

Cited by 46 publications

References 26 publications

Optimalization and cost management of lanreotide-Autogel therapy in acromegaly

Optimalization and cost management of lanreotide-Autogel therapy in acromegaly

Medical therapy: Options and uses

Predicting Therapeutic Response and Degree of Pituitary Tumour Shrinkage during Treatment of Acromegaly with Octreotide LAR

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