RANDOMIZED TRIAL OF LOPERAMIDE VERSUS DOSE-ESCALATION OF OCTREOTIDE ACETATE FOR CHEMOTHERAPY-INDUCED DIARRHEA IN BONE-MARROW TRANSPLANT ANDLEUKEMIA PATIENTS

This study compares maximal daily doses of loperamide to escalating do ses of continuous intravenous (CI) octreotide acetate in bane marrow t ransplant (BMT) and leukemia patients. Following chemotherapy, BMT and leukemia patients who developed greater than or equal to 600 ml of st ool volume in a 24-hr period were randomized to receive loperamide 4 m g po q6h or octreotide 150 mu g mixed in hyperalimentation solution or normal saline and administered CI. Patients were assessed at 48 hr in tervals for decrease in stool volume from baseline. Complete response (CR) was defined as greater than or equal to 50% from baseline stool v olume (BSV). Patients receiving octreotide who did not achieve a CR at 48 hr were dose escalated by doubling the dose to a maximum of 2,400 mu g with evaluations at 48 hr intervals. Patients receiving loperamid e who did not achieve a CR at 48 hr had treatment discontinued. A tota l of 36 patients were enrolled in the study. Of these, all were evalua ble for intention to treat, and 31 were evaluable for initial response . Based on intent to treat at the initial 48 hr, patients receiving lo peramide had a higher complete response rate (86% vs. 45%, P = 0.033) than did those who received octreotide. By treatment analysis (patient s who actually received the drug), patients receiving loperamide had a higher complete response rate (92% vs. 56%, P = 0.0448) than did thos e who received octreotide at the 150 mu g dosage level. Additional oct reotide patients eventually achieved a CR at a higher dosage level (78 %), Loperamide at maximal doses of 4 mg po q6h is more effective than octreotide 150 mu g CI in treating diarrhea following chemotherapy in BMT and leukemia patients, Higher doses of octreotide may be required in a significant number of patients not responding to lower doses. (C) 1995 Wiley-Liss, Inc.