Giustina A, Mazziotti G, Torri V, Spinello M, Floriani I, Melmed S. Meta-analysis on the effects of octreotide on tumor mass in acromegaly.
PLoS One 2012;
7:e36411. [PMID:
22574156 PMCID:
PMC3344864 DOI:
10.1371/journal.pone.0036411]
[Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 04/09/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND
The long-acting somatostatin analogue octreotide is used either as an adjuvant or primary therapy to lower growth hormone (GH) levels in patients with acromegaly and may also induce pituitary tumor shrinkage.
OBJECTIVE
We performed a meta-analysis to accurately assess the effect of octreotide on pituitary tumor shrinkage.
DATA SOURCES
A computerized Medline and Embase search was undertaken to identify potentially eligible studies.
STUDY ELIGIBILITY CRITERIA
Eligibility criteria included treatment with octreotide, availability of numerical metrics on tumor shrinkage and clear definition of a clinically relevant reduction in tumor size. Primary endpoints included the proportion of patients with tumor shrinkage and mean percentage reduction in tumor volume.
DATA EXTRACTION AND ANALYSIS
The electronic search identified 2202 articles. Of these, 41 studies fulfilling the eligibility criteria were selected for data extraction and analysis. In total, 1685 patients were included, ranging from 6 to 189 patients per trial. For the analysis of the effect of octreotide on pituitary tumor shrinkage a random effect model was used to account for differences in both effect size and sampling error.
RESULTS
Octreotide was shown to induce tumor shrinkage in 53.0% [95% CI: 45.0%-61.0%] of treated patients. In patients treated with the LAR formulation of octreotide, this increased to 66.0%, [95% CI: 57.0%-74.0%). In the nine studies in which tumor shrinkage was quantified, the overall weighted mean percentage reduction in tumor size was 37.4% [95% CI: 22.4%-52.4%], rising to 50.6% [95% CI: 42.7%-58.4%] with octreotide LAR.
LIMITATIONS
Most trials examined were open-label and had no control group.
CONCLUSIONS
Octreotide LAR induces clinically relevant tumor shrinkage in more than half of patients with acromegaly.
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