Therapeutic efficacy of the somatostatin analog SMS 201-995 (octreotide) in acromegaly: effects of dose and frequency and long-term safety

Article Abstract:

Acromegaly, a chronic disease affecting middle-aged persons, is characterized by lengthening and enlargement of bones of the extremities and certain skull bones. Since acromegaly results from excess production of growth hormone (GH), it may be treated with octreotide, a form of somatostatin, a hormone that prevents the release of GH. The effectiveness of octreotide in treating acromegaly and the octreotide-related risk for developing cholelithiasis, or formation of gallstones, were assessed. The study included 19 patients with acromegaly and 25 normal subjects. Octreotide was administered in varying doses over a period of 6 to 12 weeks. A dose of 100 micrograms of octreotide given two or three times a day was effective in decreasing GH levels. Increasing the dose of octreotide from 100 to 500 micrograms did not further reduce GH levels. However, switching from 500 micrograms of octreotide twice daily to 333 micrograms of the drug three times a day caused a significant decrease in GH levels. The levels of GH reached normal values in 8 of the 19 patients. Gallstones developed in 9 of 18 patients following octreotide therapy. These findings demonstrate that a thrice daily regimen was more effective than a twice daily regimen of octreotide, and that increasing the dose over 100 micrograms did not produce further reduction of GH levels. Octreotide improved biochemical abnormalities in 40 percent of patients with acromegaly, although it increased the risk of developing cholelithiasis. Octreotide may be used as a first-line therapy, or as a supplement to radiation or surgery in treating acromegaly. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dosage and administration

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Octreotide is effective in acromegaly but often results in cholelithiasis

Article Abstract:

Acromegaly is a chronic disease of middle-aged persons that is characterized by lengthening and enlargement of bones of the extremities and certain head bones. Since acromegaly results from excess production of growth hormone (GH), it may be treated with octreotide, a form of somatostatin, a hormone that prevents the release of GH. Levels of GH are lowered most successfully by three doses of octreotide daily or by continuous octreotide injection into the skin by a miniature pump. Some patients may be resistant to regular doses of octreotide, because they lack the receptors, or specific cell membrane binding sites, for this hormone. Normal GH blood levels range from two to three nanograms per liter of blood, and may reach a high level of not more than ten micrograms per liter of blood. Overgrowth of soft tissue and skeleton in acromegaly is due to factors called somatomedins, particularly insulin-like growth factor 1 (IGF-1). This factor serve as a useful indicator of hormonal activity in acromegaly. Octreotide therapy increases the risk of cholelithiasis, or the formation of gallstones. Sixty-five percent of patients with somatostatin-secreting tumors develop cholelithiasis. Several studies have demonstrated that patients receiving octreotide treatment develop gallstones. Octreotide may be used as an alternative to radiation in treating persistent hormonal disturbances in acromegaly. In addition to causing cholelithiasis, octreotide is a very costly drug. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Gallstones, editorial

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Octreotide treatment of acromegaly: a randomized, multicenter study

Article Abstract:

Octreotide may be an effective treatment for acromegaly, a progressive enlargement of the head, face, hands and feet. Acromegaly is caused by excess secretion of growth hormone (GH). Among 115 patients with acromegaly, 60 were injected subcutaneously with 100 micrograms of octreotide and 55 received a placebo, or an inactive substance, every eight hours over a four-week period. Blood levels of GH dropped significantly in patients treated with octreotide, but not in those who received a placebo. Among 104 patients who completed four weeks of treatment, 50 were injected with 100 micrograms of octreotide and 54 were injected with 250 micrograms of octreotide every eight hours for six months. Blood levels of GH dropped significantly in 67% of the patients taking low-dose octreotide and in 73% of those taking high-dose octreotide.

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