Use Of Octreotide LAR Research Articles

THU029 Subcutaneous Self-injections Of Lanreotide Is a Good Alternative For Acromegalic Patients With Long COVID Treated With Anticoagulants

Abstract Disclosure: I.N. Rosa: None. L.A. Naves: None. Background: Acromegaly control during pandemics was an important challenge. Telemedicine was a resource to provide health care, associated to electronic prescription sent directly to central pharmacy and drugs delivered to patients' home avoided treatment disruption in 2020 and 2021. The concomitant use of anticoagulants in Covid patients is a major concern because of risk of muscle hematomas. We describe here the replacement of Octreotide LAR to Somatuline Autogel in long Covid acromegalic patients with thromboembolic co-morbidities. Methods: We describe a sample of acromegalic patients, diagnosed with long Covid and thromboembolic co-morbidities. All patients were previously submitted to transsphenoidal surgery for somatotropic tumors and were controlled by mensal injections of octreotide LAR. Outpatient management was remodeled to simplify access to care by (1) adoption of virtual meetings; (2) collection of blood samples at home; (3) abolishment of printed prescription and provision of electronic files directly to central pharmacy; and (4) replacement of intramuscular injections for subcutaneous self injection of Lanreotide- Autogel. Results: From our cohort of 128 acromegalic patients, coronavirus disease (COVID-19) was confirmed in18%, although, long COVID, and use of anticoagulant drugs for more than 4 months was observed in 8 cases, 5 women, median age 68 years. Patients adopted self injections monthly and maintained disease control in 75% of cases with good adherence. Local side-effects, as injection-site pain, equimosis were observed less frequently than reported by the patients in previous use of Octreotide LAR. Conclusion: Telemedicine was a feasible tool in acromegalic patients with Long Covid. The replacement of intramuscular injections of Octreotide LAR for Lanreotide Autogel self injected subcutaneously allowed stability of disease control and provided an alternative to injections administered in the health care Presentation: Thursday, June 15, 2023

Clinical improvement of hyperglycemia after use of octreotide lar in a patient with acromegaly who presented with nonketotic hyperosmolar state

Clinical improvement of hyperglycemia after use of octreotide lar in a patient with acromegaly who presented with nonketotic hyperosmolar state

The LARO-MEN1 study: a longitudinal clinical experience with octreotide Long-Acting Release in patients with Multiple Endocrine Neoplasia type 1 Syndrome.

Multiple endocrine neoplasia type 1 (MEN1) is a rare hereditary tumoral syndrome, featured by a combination of neoplasms of various endocrine and nonendocrine tissues. Approximately 33% of MEN1-related deaths are due to the malignant behaviour of well-differentiated neuroendocrine tumors (NETs), for which a preventive surgical treatment is not feasible. Somatostatin analogues (SSA) have been employed in the treatment of NETs in the stage of advanced or metastatic disease, in order to control the growth and secretion of tumor lesions. A longitudinal, open label study named "LARO-MEN1" was undertaken in order to assess whether early medical treatment with long-acting SSA could act as a preventive approach in small MEN1-related gastroenteropancreatic (GEP) NETs. Thirty consecutive patients affected by MEN1 were screened and 8 patients with small (<2 cm) NETs and abnormal laboratory values of at least one of the GEP hormones were administered octreotide acetate slow-release formulation (LAR) (10 mg i.m. every 28 days). Octreotide LAR was effective in decreasing GEP hormones and overall safe in the majority of patients up to six years of treatment, maintaining the disease stable also in terms of tumor size. The positive outcomes of this study in MEN1 patients reinforce the results obtained in advanced NETs on the use of SSA, opening to the opportunity for preventive use of octreotide LAR, aimed to delay or even avoid surgery in these patients.

Octreotide LAR treatment of acromegaly in "real life": long-term outcome at a tertiary care center.

To report our day-to day experience with the long-term use of octreotide LAR in the treatment of acromegaly. Patients with acromegaly managed between 2003 and 2012 with octreotide LAR for a median of 27 months (interquartile ranges 12-60) and who had not received radiation therapy or concomitant treatment with cabergoline were retrospectively evaluated. Both primarily treated patients (n = 33) and patients who received octreotide after failed pituitary surgery (adjunctive treatment, n = 124) were included. Full biochemical response was defined as the achievement of a GH <2.5 ng/mL and an IGF-1 <1.2 times the upper limit of normal (× ULN); we also evaluated efficacy using a GH cut off of <1 ng/mL. Over 60% of the patients achieved a GH of <2.5 ng/mL. The combined GH (<2.5 ng/mL) and IGF-1 (<1.2 × ULN) target was achieved by 35.5 and 33.6% of the patients treated primarily and adjunctively, respectively; these figures dropped to 22.6 and 23% when using a GH target of <1 ng/mL. All patients reported a significant improvement in acromegalic symptoms. Lower pretreatment GH and IGF-1 levels were both associated with a higher probability of achieving the composite biochemical target. Currently recommended GH and IGF-1 targets are reached by <36% of patients treated with octreotide LAR in a day-to day practice context. Nevertheless, in most instances a clinical benefit and an improvement in biochemical markers can be clearly documented.

Octreotide LAR use among elderly patients with carcinoid syndrome and survival outcomes: A population-based analysis.

322 Background: Octreotide LAR is indicated for the treatment of carcinoid syndrome, diarrhea related to VIPoma, and may delay tumor growth in neuroendocrine tumors (NETs). The pattern of octreotide LAR use in clinical practice and its impact on survival outcomes has not been well-documented. Methods: Using the SEER-Medicare database, we identified NET patients diagnosed between 7/1999 and 12/2007. We excluded those under age 65, enrolled in HMOs, and without continuous Part A and B enrollment within 12 months of diagnosis. Potential indication for octreotide use was defined as ≥ 2 claims for carcinoid syndrome, flushing, diarrhea, or malignant islet cell neoplasm within first year of diagnosis, with the first claim occurring within 6 months of diagnosis. HCPCS codes, J2352 and J2353, were used to identify octreotide LAR treatment. Multivariate logistic regression and Cox proportional hazard survival analyses were performed to ascertain factors associated with octreotide use and evaluate impact of octreotide use on survival; covariates included age, race, region, comorbidity score, urban/rural status, tumor characteristics, neighborhood socioeconomic status and year of diagnosis. Results: Among those with potential indication for octreotide use (carcinoid syndrome and islet cell), 264 (49%) out of 539 distant stage patients, and 83 (10%) out of 850 patients with local regional disease were started on octreotide LAR within 6 months of diagnosis. Multivariate logistic regression showed that patients living in the southern region were less likely to use octreotide. Multivariate proportional hazard model showed that octreotide LAR provided a significant 5-year survival benefit for distant stage patients (HR=.80, p-value=.047); while this survival benefit was not shown for the local/regional stage patients (HR=.97, p-value=.89). Conclusions: This retrospective study suggests a possible survival benefit for use of octreotide LAR in distant stage elderly patients with carcinoid syndrome. Data also suggest that many elderly patients with claims for carcinoid syndrome did not receive octreotide LAR therapy within 6 months of diagnosis. Further studies and improved education are warranted.

Octreotide LAR for the treatment of acromegaly

Background: Somatostatin analogs previously considered as adjuvant therapy in acromegaly are increasingly used as a first-line therapy in selected cases. Objective: To review the octreotide LAR pharmacological and clinical data, and discuss the impact of this agent on current treatment regimens. Methods: We reviewed PubMed publications since the first use of octreotide LAR in acromegaly, and historical articles related to the discovery and development of this molecule. We chose, for efficacy and safety data, reviews, clinical and randomized controlled trials that included ≥ 10 patients. Results/conclusion: Octreotide LAR controls acromegaly in approximately 50 – 60% of patients by inhibiting GH and IGF-I secretion, and by reducing tumor size. This drug is well tolerated in most patients.

Octreotide in Palliative Treatment of Hepatic Metastases: Is it Effective for Clinical Stabilization?

Octreotide in Palliative Treatment of Hepatic Metastases: Is it Effective for Clinical Stabilization?

Case Study of a 15-Year-old Boy with McCune-Albright Syndrome Combined with Pituitary Gigantism: Effect of Octreotide-long Acting Release (LAR) and Cabergoline Therapy

The use of octreotide-LAR and cabergoline therapy has shown great promise in adults with acromegaly; however, the experience in pediatric patients has rarely been reported. We described a clinical course of a 15-year-old boy of McCune-Albright syndrome (MAS) with pituitary gigantism. At the age of 8 years, a growth hormone (GH) and prolactin (PRL) producing pituitary adenoma was diagnosed at our hospital. He also had multiple fibrous dysplasia, so that he was diagnosed as having MAS. The tumor was partially resected, and GNAS1 gene mutation (R201C) was identified in affected tissues. We introduced octreotide to suppress GH secretion (100 mug 2/day s.c). During therapy with octreotide, IGF-1 and GH levels could not be suppressed and the patient frequently complained of nausea from octreotide treatment. Therefore, the therapy was changed to monthly injections of octreotide-LAR at the age of 12.3 years and was partially effective. However, as defect of left visual field worsened due to progressive left optic canal stenosis, he underwent second neurological decompression of the left optic nerve at 13.4 years of age. After surgery, in addition to octreotide-LAR, cabergoline (0.25 mg twice a month) was started. This regimen normalized serum levels of GH and IGF-1; however, he showed impaired glucose tolerance and gallstones at 15.7 years of age. Therefore, the dose of octreotide-LAR was reduced to 10 mg and the dose of cabergoline increased. This case demonstrated the difficulty of treating pituitary gigantism due to MAS. The use of octreotide-LAR and cabergoline should be considered even in pediatric patients; however, adverse events due to octreotide-LAR must be carefully examined.

New strategies for the prevention and reduction of cancer treatment-induced diarrhea

Objectives To describe possible new strategies for the prevention of CTID. Data sources Abstracts presented at oncology meetings, primary and secondary literature, trial protocols, and clinical experience. Conclusion Patients who have experienced an episode of diarrhea are at high risk for developing diarrhea with additional cycles of chemotherapy or radiation. One preventive strategy that holds out promise is the use of octreotide LAR as prophylaxis. This strategy should be considered for patients with a prior cycle complicated by persistent (lasting more than 48 hours) diarrhea of any severity, or by diarrhea of grades 3 and higher. Implications for nursing practice With preventive intervention and aggressive management of breakthrough symptoms, CTID may no longer pose a significant threat to patient comfort and well-being.