Ph. Davies et al., LONG-TERM THERAPY WITH LONG-ACTING OCTREOTIDE (SANDOSTATIN-LAR(R)) FOR THE MANAGEMENT OF ACROMEGALY, Clinical endocrinology, 48(3), 1998, pp. 311-316
OBJECTIVES To evaluate the efficacy and safety of a long-acting prepar
ation of the somatostatin analogue octreotide, Sandostatin-LAR(R) (SMS
-LAR) for the treatment of acromegaly, DESIGN AND PATIENTS Thirteen pa
tients with acromegaly received intramuscular injections of SMS-LAR 20
-40 mg at 4-6-week intervals for a period of up to 3 years, MEASUREMEN
TS Serial measurement of serum GH and IGF-1 concentrations were obtain
ed, Symptoms related to acromegaly were scored by patients at baseline
and following each injection, Serial gallbladder ultrasound and pitui
tary imaging was performed throughout the study, RESULTS One patient w
as withdrawn from the study after 6 months because of continued gastro
intestinal side effects; 4 patients were treated with monthly injectio
ns for 12 months and 8 patients with injections at either 1 month or 6
-week intervals for 36 months; hence data is presented for n=12 for up
to 12 months and thereafter n=8, SMS-LAR significantly reduced serum
GH and IGF-1 values: for the whole group GH concentrations fell from 2
4.8 +/- 4.2 mU/l (mean +/- SE) at baseline to 5.2 +/- 0.8 mU/l at 12 m
onths (P < 0.01, n=12), In the 8 patients treated for 3 years GH fell
from 27.8 +/- 6.1 mU/l at baseline to 4.2 +/- 0.8 mU/l at the end of 3
years (P < 0.01, n=8), GH fell to < 10 mU/l in all subjects and was <
5 mU/l in 50% after both 1 and 3 years. IGF-1 concentrations fell fro
m 95 +/- 13 nmol/l at baseline to 63 +/- 13 nmol/l after 1 year(P < 0.
01, n=12; reference range < 65 nmol/l). In the 8 patients treated for
3 years IGF-1 concentrations fell from 119 +/- 14 nmol/l at baseline t
o 60 +/- 13 nmol/l after 3 years (P < 0.001, n=8), IGF-1 was < 65 nmol
/l in 60% of patients after 1 year and 75% after 3 years, Treatment re
sulted in trends towards improvement in symptoms of acromegaly and sta
tistically significant improvement in sweating, There was no evidence
of tachyphylaxis or evidence to suggest development of glucose intoler
ance, Only 2 patients (15%) developed gallbladder sludge which was asy
mptomatic; no patient developed gallstones. CONCLUSIONS We conclude th
at SMS-LAR is a safe, effective and well tolerated treatment, making i
t an important therapeutic option in the management of acromegaly.