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Sandostatin LAR in Acromegalic Patients: Long Term Treatment

Section of Endocrinology, Medical Department B (A.K.F., J.H., J.J.) and Department of Neuroradiology (S.B.), Rikshospitalet, University of Oslo, Oslo, Norway; and Sandoz Pharma Ltd. (I.L., P.M., C.B.), Basel, Switzerland

Address all correspondence and requests for reprints to: Dr. Anette Kvistborg Fløgstad, Section of Endocrinology, Medical Department B, Rikshospitalet, 0027 Oslo, Norway.

We have evaluated the long term effects and safety of Sandostatin LAR, a long acting formulation of octreotide, during 18 subsequent injections given every fourth week to 14 octreotide-sensitive acromegalic patients. The dosages (20, 30, or 40 mg) were adjusted according to GH response, side-effects, or symptom relief and assessed on day 28 after each injection. We found a stable and consistent suppression of GH and insulin-like growth factor (IGF-I) during the entire study period. Daily mean GH levels were suppressed below 2 µg/L in 9, to between 2–5 µg/L in 3, and to between 5–10 µg/L in 2 patients. The corresponding IGF-I values were suppressed to below 500 µg/L in 9 patients and to between 500-1000 µg/L in the remaining 5 patients. Increasing the dosage of Sandostatin LAR from 20 to 30 mg had no obvious additional effect on GH suppression, but provided a further decrease in IGF-I levels. Forty milligrams of the drug had no additional effect on GH or IGF-I compared to 30 mg. Acromegalic signs and symptoms improved during treatment. Although the fluctuations of daily mean octreotide levels were high, dosage increments caused an increase in the average serum concentration in the individual patient. Pituitary tumor size reduction was seen in all previously untreated patients (n = 4). We found only minor changes in glucose metabolism (oral glucose tolerance test and hemoglobin A_1C) during treatment, but no biologically relevant changes in thyroid function (TSH, T₃, and free T₄). One patient developed asymptomatic gallstones, and another acquired vitamin B12 deficiency during treatment. The drug is well tolerated during long term treatment. Sandostatin LAR may well be the future medical treatment of choice for acromegalic patients.

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