Discontinuation of octreotide LAR after long term, successful treatment of patients with acromegaly: is it worth trying?

• Published in: European journal of endocrinology Vol. 166; no. 1; pp. 21 - 26
• Main Authors: Ramírez, Claudia, Vargas, Guadalupe, González, Baldomero, Grossman, Ashley, Rábago, Julia, Sosa, Ernesto, Espinosa-de-Los-Monteros, Ana Laura, Mercado, Moisés
• Format: Journal Article
• Language: English
• Published: Bristol BioScientifica 01.01.2012
• Subjects: Acromegaly - drug therapy; Acromegaly - metabolism; Adult; Aged; Biological and medical sciences; Clinical Study; Drug Administration Schedule; Endocrinopathies; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Human Growth Hormone - metabolism; Humans; Hypothalamus. Hypophysis. Epiphysis (diseases); Insulin-Like Growth Factor I - metabolism; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Octreotide - administration & dosage; Octreotide - therapeutic use; Vertebrates: endocrinology; Endocrinopathy; Human; Peptide hormone; Diseases of the osteoarticular system; Acromegaly; Patient; Octreotide; Neuropeptide; Long term; Treatment; Analog; Pituitary diseases; Somatostatin; Endocrinology
• ISSN: 0804-4643; 1479-683X; 1479-683X
• DOI: 10.1530/EJE-11-0738

BackgroundSomatostatin analogs (SA) have been used for over 25 years in the treatment of acromegaly. A major disadvantage is the need to continue therapy indefinitely.ObjectiveTo evaluate the feasibility of discontinuing therapy in well-controlled patients with acromegaly treated chronically with SA.Design and methodsOf the 205 subjects on octreotide LAR, we selected those who met the following criteria: two or more years of treatment, a stable dose and injection interval of 20 mg every 8 weeks or longer for the previous year, no history of radiation, no cabergoline for the previous 6 months, a GH <1.5 ng/ml, and an IGF1 <1.2×upper limit of normal (ULN). Octreotide LAR was stopped and both GH and IGF1 were measured monthly for 4 months; a glucose-suppressed GH value and magnetic resonance imaging were obtained at the 4th month, thereafter, basal GH and IGF1 were measured q. 3 months, for 12–18 months. Patients were removed from the study if GH or IGF1 rose to 1.5 ng/ml or 1.2×ULN respectively.ResultsTwelve patients (ten women, mean age 48±13 years) were studied. Seven patients (58.3%) relapsed biochemically within 1 year of having stopped the SA; two patients relapsed by GH and IGF1 criteria, the remaining five patients kept GH levels within target. Five patients (41.7%) remain in remission after 12 months of follow-up. Non-recurring patients were on longer injection intervals but no other characteristic was associated with a successful withdrawal.ConclusionWithdrawal of SA is possible in a small but distinct subset of patients, particularly in those who are very well controlled on relatively low doses administered at long intervals.