Octreotide Long-Acting Repeatable in Acromegaly

Abstract

Abstract: Treatment modalities for acromegaly include transsphenoidal surgery, medical therapy, and radiotherapy. Somatostatin analogs are the medical therapy of choice in acromegaly, with octreotide long-acting repeatable (LAR) the current global leader for patients with growth hormone (GH)-secreting pituitary adenomas. In patients with acromegaly, octreotide LAR is traditionally used as postsurgical therapy in patients with persistent disease. Although surgery remains the first-line treatment option in patients with tumors likely to be completely resected, there is a growing consensus that octreotide LAR could be used as first-line therapy in select patients. Octreotide LAR has been used in the treatment of acromegaly for over 10 years, and there are a wealth of data demonstrating that it is an effective, convenient, and well-tolerated treatment for the majority of patients with this disorder. Most patients initiating treatment with somatostatin analogs begin with octreotide LAR 20 mg every 28 days. On average, 60% of patients can safely achieve normal GH and insulin-like growth factor-I levels during octreotide LAR therapy, as well as experience significant reduction in pituitary tumor volume. However, recent studies have shown that up to 80% of patients can attain biochemical control. This can be attained by regularly monitoring GH and insulin-like growth factor-I levels and by escalating the dose of octreotide LAR to 30 mg or 40 mg every 28 days. By optimizing the control of acromegaly, the comorbidities and increased risk of premature mortality associated with this disorder can be reversed in most patients.