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Optimizing Somatostatin Analog Therapy in Acromegaly

Long-Acting Formulations

  • Leading Article
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Treatments in Endocrinology

Abstract

Somatostatin peptide analogs have revolutionized the medical treatment of patients with acromegaly. More recent deep intramuscular depot preparations have further improved control, with consistent suppression of growth hormone secretion and optimal lowering of insulin-like growth factor-1. Effective control of growth hormone should, with long-term use, reduce morbidity and mortality from acromegaly and has been shown to result in partial involution of the pituitary adenoma in the majority of treated patients.

The currently available depot formulations allow for an injection frequency of 14 days (lanreotide LA 30mg) to 28 days (octreotide LAR 20mg) according to the manufacturers’ recommendations. In clinical practice, dose titration by evaluating a growth hormone day profile prior to the next injection can extend the interval between injection (to 6 or even 8 weeks in certain individuals). This is especially true for octreotide LAR, which also has increased flexibility regarding dosage with a 10 and 30mg preparation. The annual ‘drug cost’ is broadly similar between the two formulations though the additional expenditure on nurse time and clinic visits incurred by an increased injection frequency is a significant consideration. Decreased injection frequency improves acceptability for the patient without a loss in treatment efficacy. A subjective return of typical acromegalic symptoms, such as sweating and headache, also seem to be useful in predicting the timing of the next injection.

Other formulations and doses of lanreotide are currently being evaluated, but more interestingly, newer analogs with greater efficacy at the type 5 somatostatin receptor subtype, and pan-receptor analogs, are being developed. These peptides, in conjunction with the likely availability of a growth hormone receptor blocking agent (pegvisomant), will further expand the medical therapy options for patients with acromegaly.

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Notes

  1. Use of tradenames is for identification purposes only and does not imply endorsement.

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Acknowledgements

The authors have performed approved clinical trials for both Ipsen and Novartis pharmaceutical companies in the evaluation of lanreotide and octreotide as part of multicenter studies.

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  1. Medicines Information and Clinical Trials Unit, Royal Victoria Infirmary, Newcastle-upon-Tyne, NE1 4LP, England

    John J. Gilroy &  R. Andrew James

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  1. John J. Gilroy
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  2. R. Andrew James
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Correspondence to R. Andrew James.

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Gilroy, J.J., James, R.A. Optimizing Somatostatin Analog Therapy in Acromegaly. Mol Diag Ther 1, 149–154 (2002). https://doi.org/10.2165/00024677-200201030-00002

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