Clinical efficacy and safety results for dose escalation of somatostatin receptor ligands in patients with acromegaly: a literature review.
Bottom Line: Related articles in non peer-reviewed journals were excluded.We found that dose escalation could provide additional biochemical control of acromegaly in patients who are inadequately controlled with conventional starting doses of octreotide LAR and lanreotide Autogel(®).Furthermore, patients should routinely have their GH and IGF-1 levels closely monitored and their SRL dose increased or decreased thereafter according to individual response.
Affiliation: Department of Neurological Surgery, Northwest Pituitary Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, (BTE 472), Portland, OR 97239, USA. email@example.comShow MeSH
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Mentions: The efficacy of titrated versus fixed doses of lanreotide ATG has been compared and the same improvement in patient outcome with dose optimization was reported. After 1¬†year of treatment, the mean plasma GH and IGF-1 concentrations in 130 patients were significantly lower for titrated lanreotide ATG than with fixed doses of lanreotide ATG (Fig.¬†3) . The efficacy of lanreotide ATG in decreasing GH and IGF-1 has also been confirmed in patients previously treated with octreotide LAR. After a washout period, patients were switched to lanreotide ATG (120¬†mg) and the time between doses was adjusted based on the GH and IGF-1 response. Based on the need for additional treatment, the frequency was increased in 12/23 patients to every 4¬†weeks, 4/23 patients remained on the original starting dose every 6¬†weeks, and 6/23 patients were reduced to treatment every 8¬†weeks. At the end of the study, the number of patients that achieved GH <2.5¬†őľg/l and normalized IGF-1 was 62 and 43% patients, respectively . In another study, 63 patients with acromegaly were treated with lanreotide ATG (90¬†mg/4¬†weeks) with the dose adjusted to achieve normalized, age- and sex-matched, levels of IGF-1. By the end of the study 73% of patients required an increase to 120¬†mg . A randomized placebo-controlled study in an unselected population of 99 patients published in 2010 showed that lanreotide ATG was effective in controlling both GH and IGF-1 hypersecretion: 54% of patients had normalized IGF-1 and 38% achieved a combined criterion of GH level ‚Č§2.5¬†őľg/l and normalized IGF-1. Unsurprisingly, at the end of the open-label phase, 65/99 patients were on the highest dose (120¬†mg every 4¬†weeks) .Fig.¬†3
Affiliation: Department of Neurological Surgery, Northwest Pituitary Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, (BTE 472), Portland, OR 97239, USA. firstname.lastname@example.org