Can we predict long-term remission after somatostatin analog withdrawal in patients with acromegaly? Results from a multicenter prospective trial

Lucio Vilar, Maria Fleseriu, Luciana Ansaneli Naves, José Luciano Albuquerque, Patrícia Sampaio Gadelha, Manuel Dos Santos Faria, Gilvan Cortês Nascimento, Renan Magalhães Montenegro, Renan Magalhães Montenegro

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Somatostatin analogs (SSAs) represent the mainstay of therapy in acromegaly. One of the potential disadvantages is the expected need to maintain therapy indefinitely in previously non-irradiated patients. The aim of this multicenter prospective open trial was to evaluate the likelihood of successful discontinuation of SSA therapy in well-controlled acromegalic patients who fulfilled very strict criteria: two or more years of treatment with the long-acting SSA octreotide LAR (OCT-LAR), a stable dose and injections interval every 4 weeks or longer for the previous year, GH levels <2.5 ng/ml and normal IGF-1 levels for age, a tumor remnant <10 mm, no history of radiotherapy, and no use of cabergoline or pegvisomant over the previous 6 months. Disease recurrence was defined as an increase of IGF-1 to levels above 1.2-fold the upper limit of normal (ULN). Out of 220 patients, 20 patients (12 women and 8 men; mean age, 48.1 ± 10.3 years; age range, 27-64) treated for 2.74 ± 0.64 years (range, 2.0-4.4) were included in this prospective study and OCT-LAR therapy was stopped. Four patients (20 %) remained without clinical and biochemical/neuroradiological evidence of disease recurrence after 12-18 months of follow-up. Sixteen patients (80 %) relapsed biochemically within 9 months after drug withdrawal and restarted OCT-LAR at the same previous dose. Compared to recurring subjects, non-recurring patients had significantly lower mean IGF-1 (× ULN) levels but there were some overlapping values in both groups. No other characteristic could be identified as a predictor of successful OCT-LAR discontinuation. Our findings demonstrated that OCT-LAR withdrawal, though rare, is possible in well-selected acromegalic patients treated for at least 2 years and considered optimally controlled in hormonal and neuroradiological terms.

Original languageEnglish (US)
Pages (from-to)577-584
Number of pages8
JournalEndocrine
Volume46
Issue number3
DOIs
StatePublished - Aug 2014

Keywords

  • Acromegaly
  • Octreotide LAR
  • Treatment withdrawal

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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    Vilar, L., Fleseriu, M., Naves, L. A., Albuquerque, J. L., Gadelha, P. S., Dos Santos Faria, M., Nascimento, G. C., Montenegro, R. M., & Montenegro, R. M. (2014). Can we predict long-term remission after somatostatin analog withdrawal in patients with acromegaly? Results from a multicenter prospective trial. Endocrine, 46(3), 577-584. https://doi.org/10.1007/s12020-013-0094-9