Optimalization and cost management of lanreotide-Autogel therapy in acromegaly

Abrams, Pascale; Alexopoulou, Orsalia; Abs, Roger; Maiter, Dominique; Verhelst, Johan

doi:10.1530/eje-07-0366

Cited by 25 publications

(24 citation statements)

References 32 publications

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“…In fact, lanreotide Autogel is a new formulation of lanreotide with comparable biochemical efficacy to lanreotide SR and potential advantages for the compliance of the patients related to the type (i.e deep subcutaneous) and modality of administration [52][53][54][55][56][57][58][59][60][61]. In fact, it does not require any reconstitution procedures which, if incomplete, may result in needle blockage by microparticles.…”

Section: Discussionmentioning

confidence: 99%

Effects of lanreotide SR and Autogel on tumor mass in patients with acromegaly: a systematic review

Mazziotti,

Giustina

2009

Pituitary

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Long-acting somatostatin analogs (SSA) are widely used for the treatment of acromegaly achieving biochemical control of the disease in 50-75% of the patients. One of the goals of the treatment of acromegaly is the control of tumor growth, especially in patients in whom SSAs are used as first-line therapy. Over the recent years, there has been growing evidence that SSAs are able to induce tumor shrinkage in patients with acromegaly. However, most of the data are from patients under treatment with octreotide, either subcutaneously or intramuscularly with long-acting formulation, whereas the data on lanreotide SR or Autogel are very few. Indeed, octreotide and lanreotide, i.e. the two commercially available SSAs, show slight differences in pharmacokinetics and patterns of receptor affinities with potentially different therapeutic effects. We aimed to perform a systematic review of literature data concerning the shrinkage effects of long-acting lanreotide in patients with acromegaly. The analysis was focused on the following issues: differences in shrinkage effects between primary and secondary medical treatment, predictive value of baseline tumor volume and correlation between biochemical control and shrinkage effects. The peer-reviewed medical literature was searched to identify clinical trials studying the effects of lanreotide SR or Autogel on adenoma size in acromegaly. To be included in this analysis, studies had one of the following designs: randomized controlled trial; prospective, nonrandomized trial; retrospective study. Twenty-two studies were found to be eligible for the final analysis, in which tumor size was measured as an end-point for lanreotide treatment. Overall a total of 32.8% of patients experienced a variable degree (from 10 to 77%) of tumor shrinkage during lanreotide SR or Autogel treatment. The analysis showed that tumor shrinkage was more frequent in naïve patients as compared with those previously treated by radiotherapy, surgery or drugs other than lanreotide. The data on the correlation between tumor shrinkage and baseline tumor size were discordant, but when baseline tumor size was specified, more than 80% of patients undergoing shrinkage under lanreotide Autogel had macroadenomas. Finally, with lanreotide Autogel there was no evident correlation between biochemical response and tumor shrinkage. Our systematic review of the literature shows that lanreotide particularly when used as first-line therapy is able to quite frequently induce tumor shrinkage in patients with acromegaly. This finding suggests that this drug may have a role in the primary treatment of acromegaly.

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Section: Discussionmentioning

confidence: 99%

Effects of lanreotide SR and Autogel on tumor mass in patients with acromegaly: a systematic review

Mazziotti,

Giustina

2009

Pituitary

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“…For instance, strategies that proactively utilize pharmacological therapies in conjunction with surgery offer opportunities for improved rates of biochemical control and cure [36, 49]. Furthermore, the use of drug combination therapy and/or extended dosing intervals may also help to improve response rates and reduce SSA doses [49, 51]. Thus, although improved access to recommended therapies would be the ideal solution, Latin American clinicians may need a flexible approach in order to maximize the benefits of primary pharmacological therapy for acromegaly within their budget constraints and local access to drug resources.…”

Section: Discussionmentioning

confidence: 99%

The role of primary pharmacological therapy in acromegaly

et al. 2013

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Background and objectivesPrimary pharmacological therapy may be the only viable treatment option for many patients with acromegaly, especially those presenting with advanced disease with large inoperable tumors. Long-acting somatostatin analogs are currently the first-line treatment of choice in this setting, where they provide biochemical control and reduce tumor size in a significant proportion of patients. We herein present a brief overview of the role of primary pharmacological therapy in the treatment of acromegaly within the context of Latin America and support this with a representative case study.Case descriptionA 20 year old male presented with clinical and biochemical evidence of acromegaly. The glucose-suppressed growth hormone (GH) was 5.3 μg/L, his insulin-like growth factor-1(IGF-1) was 3.5 times the ULN and serum prolactin greater than 4,000 μg/L. Pituitary MRI revealed a large and invasive mass, extending superiorly into the optic chiasm and laterally into the left cavernous sinus. He was treated with a combination of octreotide and cabergoline with remarkable clinical improvement, normalization of GH and IGF-1 values and striking shrinkage of the adenoma.ConclusionThis case illustrates how effective the pharmacological therapy of acromegaly can be and yet at the same time, raises several important issues such as the need for life-long treatment with costly medications such as the somatostatin analogs. Access to these agents may be limited in regions where resources are restricted and clinicians face challenges in order to make the most efficient use of available options.

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“…Nevertheless, access to skilled surgeons should not dictate the choice of therapy, if pharmacological treatment is indicated. In well-controlled patients, it may be possible to increase the interval between doses without losing efficacy [33]. In a small subset of patients, it may also be possible to permanently discontinue SSA therapy, suggesting that these agents might provide permanent beneficial functional changes in GH release (at least in some patients) [34].…”

Section: Revisiting the Expert Panel Recommendations On The Managemenmentioning

confidence: 99%

A practical approach to acromegaly management in Latin America

et al. 2013

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IntroductionEvidence-based treatment guidelines have undoubtedly advanced medical practice and supported optimal management of acromegaly, but their application may be hampered by limited access to the latest treatment options.MethodsIn this retrospective, narrative review, the authors revisited existing treatment guidelines for acromegaly in Latin America. These were considered in conjunction with published evidence chosen at the authors’ discretion.FindingsIn a socially and economically diverse region, such as Latin America, any regional practice guidelines need to appreciate that recommended treatment options, such as surgery by expert pituitary surgical teams and drug therapies, especially somatostatin analogs, are often not available due to limited resources. In these instances, physicians may be obliged to apply less effective therapeutic options.ConclusionsThe current article looks at the practical aspects of acromegaly management in Latin America and discusses this in the context of existing guidelines. Furthermore, we consider potential strategies to make better use of resources through combination and multimodal approaches to treatment.

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Optimalization and cost management of lanreotide-Autogel therapy in acromegaly

Abstract: Background: Lanreotide-Autogel is a depot formulation of the somatostatin analog lanreotide used in the treatment of acromegaly. We investigated whether prolonging or shortening the interval between injections would offer any benefit.

Cited by 25 publications

References 32 publications

Effects of lanreotide SR and Autogel on tumor mass in patients with acromegaly: a systematic review

Effects of lanreotide SR and Autogel on tumor mass in patients with acromegaly: a systematic review

The role of primary pharmacological therapy in acromegaly

A practical approach to acromegaly management in Latin America

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