J Korean Soc Endocrinol JKSE Journal of Korean Society of Endocrinology 1015-6380 Korean Endocrine Society 10.3803/jkes.2005.20.4.344 Original Article Efficacy of Octreotide LAR in Acromegalic Patients Kim Ji Youn Jee Jae Hwan Yoon Chan Ho Chung Yun Jae Lee Byung Wan Cho Gun Yong Kim Sang Young Chung Jae Hoon Min Yong-Ki Lee Myung-Shik Lee Moon-Kyu Kim Kwang-Won Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 08 2005 31 08 2005 20 4 344 352 03 02 2005 03 06 2005 Copyright © 2005 Korean Endocrine Society 2005 Background

Octreotide (OC)-LAR is a long-acting preparation of octreotide which has been effectively used to suppress GH/IGF-1 hypersecretion in acromegalic patients. The clinical response, biochemical outcomes, and safety of OC-LAR were evaluated in 27 active acromegalic patients.

 Method

27 patients with an active disease status (according to the clinical picture, GH >5 µg/L and elevated age-matched IGF-1), and previously treated with bromocriptine after surgery, comprised the study population. OC-LAR was given (20 mg, i.m., every 4 week for 3 injections, then the doses were titrated individually) and the acromegalic symptoms and adverse reactions recorded. The serum levels of GH and IGF-1 were evaluated every 12 week. The acromegalic symptoms including headache, fatigue and arthralgia, improved in all patients.

 Results

Gastrointestinal side effects were transient and mild. The levels of GH significantly decreased, from 8.9 ± 3.5 to 2.9 ± 2.2 µg/L at 12 weeks (P< 0.001, vs. baseline), to 2.9 ± 2.1 µg/L after 24 weeks (P< 0.001) and to 2.5 ± 1.3 µg/L at 48 weeks (P< 0.001). The levels of IGF-1 significantly decreased, from 753.7 ± 213.6 to 429.7 ± 253.4 µg/L at 12 weeks (P< 0.001, vs. at baseline), to 405.7 ± 213.3 µg/L at 24 weeks (P< 0.001) and to 348.9 ± 144.7 µg/L at 48 weeks (P<0.001). The safelevel of GH is less than 2.5 µg/L and normal age-matched IGF-1 levels were achieved in 63 and 52% of the patients, respectively.

 Conclusion

Octreotide-LAR was well tolerated and effective as an adjuvant treatment in lowering the levels of GH and IGF-1 in active acromegalic patients

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GH (a) and IGF-1 (b) levels (mean ± SD) during treatment. GH and IGF-1 levels decreased significantly at 12 weeks and progressively suppressed. *P< 0.01 vs. basal level

Kaplan-Meier analysis for achievement of safe GH levels and IGF-1 normalization. The rate of safe GH (<2.5 µg/L) and IGF-1 normalization were 78% and 88% at 48 weeks

Individual GH level (a) and IGF-1 levels (b) at basal (upper line) and final (lower line) on OC-LAR

Correlation between the responses of GH and IGF-1 on OC-LAR. There is positive correlation between the suppression (%) of GH and IFG-1 during treatment (r=0.402, P<0.001)

The Baseline Characteristics of the Patients

Values are the mean ± SD

Overall Outcome of OC-LAR on GH and IGF-1

The Characteristics of Two Groups in Response to OC-LAR

Values are the mean ± SD. The good response defined as GH <2.5 µg/L and normal age-matched IGF-1 levels at the latest visit after treatment with OC-LAR. Suppression (%) was calculated with equation as follows: (basal level level at 12 weeks) / basal level ×100

The Multivariate Regression with Good Response on OC-LAR

The good response defined as GH <2.5 µg/L and normal age-matched IGF-1 levels at the latest visit after treatment with OC-LAR.