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Chang CL, Cai Z, Hsu SYT. A gel-forming α-MSH analog promotes lasting melanogenesis. Eur J Pharmacol 2023; 958:176008. [PMID: 37673364 DOI: 10.1016/j.ejphar.2023.176008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023]
Abstract
The α-MSH peptide plays a significant role in the regulation of pigmentation via the melanocortin 1 receptor (MC1R). It increases the DNA repair capacity of melanocytes and reduces the incidence of skin cancers. As such, α-MSH analogs could have the utility for protecting against UV-induced skin DNA damage in susceptible patients. Recently, α-MSH analogs have been approved for the treatment of erythropoietic protoporphyria, hypoactive sexual desire, or pediatric obesity. However, the delivery of these drugs requires inconvenient implants or frequent injections. We recently found that select palmitoylated melanocortin analogs such as afamelanotide and adrenocorticotropin peptides self-assemble to form liquid gels in situ. To explore the utility of these novel analogs, we studied their pharmacological characteristics in vitro and in vivo. Acylated afamelanotide (DDE 313) and ACTH1-24 (DDE314) analogs form liquid gels at 6-20% and have a significantly increased viscosity at >2.5% compared to original analogs. Using the DDE313 analog as a prototype, we showed gel-formation reduces the passage of DDE313 through Centricon filters, and subcutaneous injection of analog gel in rats leads to the sustained presence of the peptide in circulation for >12 days. In addition, DDE313 darkened the skin of frogs for >4 weeks, whereas those injected with an equivalent dose of afamelanotide lost the tanning response within a few days. Because self-assembled gels allow sustained activation of melanocortin receptors, further studies of these analogs may allow the development of effective and convenient tanning therapies to prophylactically protect against UV-induced malignant transformation of skin cells in susceptible patients.
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Affiliation(s)
- Chia Lin Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, Kweishan, Taoyuan, Taiwan
| | - Zheqing Cai
- CL Laboratory LLC, Gaithersburg, MD, 20878, United States
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Boguszewski CL, Korbonits M, Artignan A, García AM, Houchard A, Ribeiro-Oliveira A, de Herder WW. Evaluating home injection compared with healthcare-setting injection of somatostatin analogs: a systematic literature review. Endocrine 2023; 79:527-536. [PMID: 36369434 PMCID: PMC9651885 DOI: 10.1007/s12020-022-03227-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE A systematic literature review was conducted to assess the use of home injections (self/partner/healthcare provider [HCP]-administered) of somatostatin analogs (SSAs) as an alternative to healthcare-setting injections in patients with acromegaly and neuroendocrine tumors (NETs). METHODS MEDLINE/Embase/the Cochrane Library (2001-September 2021), key congresses (2019-2021), and bibliographies of relevant systematic reviews were searched. Eligible studies reported on efficacy/effectiveness, safety, adherence, patient-reported outcomes (PROs), and economic outcomes in populations receiving home injections of SSAs. RESULTS Overall, 12 studies were included, all reporting on SSAs (lanreotide Autogel/Depot or octreotide long-acting release) in acromegaly or NETs. Across four studies, home injection was associated with similar disease control in patients with acromegaly/NETs compared with healthcare-setting administration. High rates of treatment adherence were shown in two studies of patients with acromegaly receiving lanreotide injections at home. Two studies reported non-serious adverse events; incidence of adverse reactions was similar in both the home and healthcare administration settings. Preference for injection setting varied between studies and indications; nonetheless, higher satisfaction/convenience (>75% patients) was reported for home injections. Self- or partner-injection was associated with economic savings compared with administration in the healthcare setting across five studies. CONCLUSION Efficacy/effectiveness, adherence, and safety outcomes of SSAs in the home injection setting were similar to those in the healthcare setting, with high reported satisfaction and convenience. Self/partner injection also resulted in cost savings. These findings provide a basis to understand outcomes related to home injection and encourage healthcare providers to discuss optimal treatment choices with their patients.
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Affiliation(s)
- Cesar L Boguszewski
- Endocrine Division (SEMPR), Department of Internal Medicine, Federal University of Parana, Curitiba, Brazil.
| | - Márta Korbonits
- Department of Endocrinology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | | | | | | | - Wouter W de Herder
- Sector of Endocrinology, Department of Internal Medicine, Erasmus MC, Rotterdam, Netherlands
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Chang CL, Cai Z, Hsu SYT. Gel-forming antagonist provides a lasting effect on CGRP-induced vasodilation. Front Pharmacol 2022; 13:1040951. [PMID: 36569288 PMCID: PMC9772450 DOI: 10.3389/fphar.2022.1040951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
Migraine affects ∼15% of the adult population, and the standard treatment includes the use of triptans, ergotamines, and analgesics. Recently, CGRP and its receptor, the CLR/RAMP1 receptor complex, have been targeted for migraine treatment due to their critical roles in mediating migraine headaches. The effort has led to the approval of several anti-CGRP antibodies for chronic migraine treatment. However, many patients still suffer continuous struggles with migraine, perhaps due to the limited ability of anti-CGRP therapeutics to fully reduce CGRP levels or reach target cells. An alternative anti-CGRP strategy may help address the medical need of patients who do not respond to existing therapeutics. By serendipity, we have recently found that several chimeric adrenomedullin/adrenomedullin 2 peptides are potent CLR/RAMP receptor antagonists and self-assemble to form liquid gels. Among these analogs, the ADE651 analog, which potently inhibits CLR/RAMP1 receptor signaling, forms gels at a 6-20% level. Screening of ADE651 variants indicated that residues at the junctional region of this chimeric peptide are important for gaining the gel-forming capability. Gel-formation significantly slowed the passage of ADE651 molecules through Centricon filters. Consistently, subcutaneous injection of ADE651 gel in rats led to the sustained presence of ADE651 in circulation for >1 week. In addition, analysis of vascular blood flow in rat hindlimbs showed ADE651 significantly reduces CGRP-induced vasodilation. Because gel-forming antagonists could have direct and sustained access to target cells, ADE651 and related antagonists for CLR/RAMP receptors may represent promising candidates for targeting CGRP- and/or adrenomedullin-mediated headaches in migraine patients.
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Affiliation(s)
- Chia Lin Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Zheqing Cai
- CL Laboratory LLC, Gaithersburg, MD, United States
| | - Sheau Yu Teddy Hsu
- Adepthera LLC, San Jose, CA, United States,*Correspondence: Sheau Yu Teddy Hsu,
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Chang CL, Cai Z, Hsu SYT. Sustained Activation of CLR/RAMP Receptors by Gel-Forming Agonists. Int J Mol Sci 2022; 23:ijms232113408. [PMID: 36362188 PMCID: PMC9655119 DOI: 10.3390/ijms232113408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Adrenomedullin (ADM), adrenomedullin 2 (ADM2), and CGRP family peptides are important regulators of vascular vasotone and integrity, neurotransmission, and fetoplacental development. These peptides signal through CLR/RAMP1, 2, and 3 receptors, and protect against endothelial dysfunction in disease models. As such, CLR/RAMP receptor agonists are considered important therapeutic candidates for various diseases. Methods and Results: Based on the screening of a series of palmitoylated chimeric ADM/ADM2 analogs, we demonstrated a combination of lipidation and accommodating motifs at the hinge region of select peptides is important for gaining an enhanced receptor-activation activity and improved stimulatory effects on the proliferation and survival of human lymphatic endothelial cells when compared to wild-type peptides. In addition, by serendipity, we found that select palmitoylated analogs self-assemble to form liquid gels, and subcutaneous administration of an analog gel led to the sustained presence of the peptide in the circulation for >2 days. Consistently, subcutaneous injection of the analog gel significantly reduced the blood pressure in SHR rats and increased vasodilation in the hindlimbs of adult rats for days. Conclusions: Together, these data suggest gel-forming adrenomedullin analogs may represent promising candidates for the treatment of various life-threatening endothelial dysfunction-associated diseases such as treatment-resistant hypertension and preeclampsia, which are in urgent need of an effective drug.
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Affiliation(s)
- Chia Lin Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, Kweishan, Taoyuan 20878, Taiwan
| | - Zheqing Cai
- CL Laboratory LLC, Gaithersburg, MD 20878, USA
| | - Sheau Yu Teddy Hsu
- Adepthera LLC, San Jose, CA 95138, USA
- Correspondence: ; Tel.: +1-650-799-3496
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Giustina A, Legg E, Cesana BM, Frara S, Mortini P, Fleseriu M. Results from ACROCOVID: an international survey on the care of acromegaly during the COVID-19 era. Endocrine 2021; 71:273-280. [PMID: 33415577 PMCID: PMC7790473 DOI: 10.1007/s12020-020-02565-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/22/2020] [Indexed: 12/11/2022]
Abstract
With most global healthcare resources focused on COVID-19, altered resource allocation is disrupting the continuum of care for chronic endocrine conditions, including acromegaly. In order to assess the effects of COVID-19 on care of patients with acromegaly, we conducted an international online survey of endocrinologists. The questionnaire was drafted by a Steering Committee of acromegaly experts and covered both respondent demographics, contact and communication with patients, and patient care. Respondent awareness was generated through social media campaigns and the survey completed online using Google forms. The majority of endocrinologists who responded (N = 84) were based in Europe (67.9%) and were female (58.3%). Slightly more than half of respondents worked in a specialized pituitary center (52.4%) and a large minority cared for more than 50 acromegaly patients (47.6%). Most respondents (85.7%) indicated surgery was their first-line treatment, with only 14.3% indicating medical therapy as a first-choice treatment option. One-third (33.3%) of respondents reported having delayed a planned surgery due to a lack of COVID-19 testing provision and 54.8% due to a lack of surgical provision; 19.1% indicated that a lack of personal protective equipment had reduced their ability to treat patients with acromegaly. Just 21.4% of respondents reported no negative effects from the pandemic on diagnostic practice patterns, and just 19.1% reported no negative effect on patient follow-up practices. Many respondents (55.9%) indicated that remote methods had improved their ability to communicate with their patients and 69.0% indicated that they would continue to use methods of consultation necessitated by the COVID-19 pandemic. Our data suggest the COVID-19 pandemic is substantially affecting the care of acromegaly. However, these results also suggest that endocrinologists are embracing aspects of the 'new normal' to create a novel continuum of care better suited to the presumed post-COVID-19 environment. The goal of these changes must be both to improve care while shielding patients from more severe involvement in concomitant acute illnesses such COVID-19.
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Affiliation(s)
- Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy.
| | | | - Bruno Mario Cesana
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy
| | - Stefano Frara
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy
| | - Pietro Mortini
- Neurosurgery, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy
| | - Maria Fleseriu
- Pituitary Center, Oregon Health and Science University, Portland, OR, USA
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Cella D, Evans J, Feuilly M, Neggers S, Van Genechten D, Herman J, Khan MS. Patient and Healthcare Provider Perspectives of First-Generation Somatostatin Analogs in the Management of Neuroendocrine Tumors and Acromegaly: A Systematic Literature Review. Adv Ther 2021; 38:969-993. [PMID: 33432541 PMCID: PMC7799425 DOI: 10.1007/s12325-020-01600-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/05/2020] [Indexed: 11/24/2022]
Abstract
Introduction Somatostatin analogs (SSAs) are used to treat neuroendocrine tumors (NETs) and acromegaly. Two first-generation SSAs, octreotide long-acting release (OCT LAR) and lanreotide autogel/depot (LAN), are available. A systematic literature review (SLR) was conducted to investigate which characteristics beyond efficacy are most important in patient and healthcare practitioner (HCP) experience of LAN and OCT when used to treat acromegaly and NETs. Methods MEDLINE, Embase, the Cochrane Library, and Database of Abstracts of Reviews of Effect were searched from database inception to January 2019 with terms for first-generation SSAs, NETs, acromegaly, preferences, decision-making, and human factors. Key congresses in 2016–2018 and SLR bibliographies were hand-searched. Two independent reviewers screened articles at title/abstract and full-text stage. Publications fulfilling pre-specified inclusion criteria reported patient or HCP perspectives of LAN or OCT, or any factors affecting treatment perspectives for NETs or acromegaly. Results A total of 1110 unique records were screened, of which 21 studies were included, reporting from the perspectives of patients (n = 18) and/or HCPs (n = 9). Perspectives were collected using shared decision-making frameworks, questionnaires, informal patient opinion, and a Delphi panel. Where patient preference was specifically reported, LAN was preferred in 4/5 studies and OCT LAR in 1/5. Common factors underlying treatment experience included technical problems with injections and associated pain, emotional quality/anxiety of injections, time and convenience of treatment administration, and independence. Immediate aspects of injections appeared most important to patients, though the possibilities of extended dosing intervals and self-/partner-injection with LAN were also notable factors. Conclusions Study outcomes favored LAN in this SLR, with factors surrounding injection administration most influential in treatment experience. The findings of this SLR provide a basis that could inform development of decision-making criteria, with patient and HCP treatment perspectives considered. Future studies should utilize a common method to report preference and associated drivers. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-020-01600-x.
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Affiliation(s)
- David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | | | - Sebastian Neggers
- Department of Medicine, Section Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dirk Van Genechten
- Belgian Neuroendocrine Tumour (NET) and Multiple Endocrine Neoplasia (MEN) Association, Blankenberge, Belgium
- International Neuroendocrine Cancer Alliance (INCA), Boston, MA, USA
| | - Jackie Herman
- Canadian Neuroendocrine Tumour Society, Cornwall, ON, Canada
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Broersen LHA, Zamanipoor Najafabadi AH, Pereira AM, Dekkers OM, van Furth WR, Biermasz NR. Improvement in Symptoms and Health-Related Quality of Life in Acromegaly Patients: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2021; 106:577-587. [PMID: 33245343 PMCID: PMC7823264 DOI: 10.1210/clinem/dgaa868] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Whereas biochemical response is often used as a primary study outcome, improvement in symptoms and health-related quality of life (HRQoL) is the relevant goal for patients to consider treatment successful. We performed a systematic review and meta-analysis to assess the effect of treatment on symptoms and HRQoL in acromegaly. METHODS Seven electronic databases were searched for longitudinal studies assessing patient-reported symptoms or HRQoL in acromegaly. Meta-analyses were performed to assess differences during treatment for the Acromegaly Quality of Life Questionnaire (AcroQoL) and Patient-Assessed Acromegaly Symptom Questionnaire (PASQ), and standardized mean difference (SMD) for individual symptoms (interpretation: 0.2 small, 0.5 moderate, and 0.8 large effect). Treatment-naive and previously treated patients were assessed separately. RESULTS Forty-six studies with 3301 patients were included; 24 contributed to quantitative analyses. Thirty-six studies used medication as main treatment, 1 transsphenoidal adenomectomy, and 9 various treatments. Symptoms and HRQoL both improved: AcroQoL increased 2.9 points (95% CI, 0.5 to 5.3 points), PASQ decreased -2.3 points (95% CI, -1.3 to -3.3 points), and individual symptom scores decreased for paresthesia -0.9 (95% CI, -0.6 to -1.2), hyperhidrosis -0.4 (95% CI, -0.1 to -0.6), fatigue -0.3 (95% CI, -0.1 to -0.6), arthralgia -0.3 (95% CI, -0.1 to -0.5), headache -0.3 (95% CI, 0.0 to -0.6), and soft-tissue swelling -0.2 (95% CI, 0.0 to -0.4). CONCLUSION Symptoms and HRQoL improved during acromegaly treatment. Consensus is needed on which symptoms should be included in a potential core outcome set, taking into account symptom frequency, severity, and sensitivity to change, which can be used in clinical practice and as outcome in trials.
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Affiliation(s)
- Leonie H A Broersen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, ZA Leiden, the Netherlands
| | - Amir H Zamanipoor Najafabadi
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, ZA Leiden, the Netherlands
- Center for Innovative Pituitary Care and Cranial Base Surgery, Leiden University Medical Center, ZA Leiden, the Netherlands
- University Neurosurgical Centre Holland, Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, ZA Leiden and The Hague, the Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, ZA Leiden, the Netherlands
- Center for Innovative Pituitary Care and Cranial Base Surgery, Leiden University Medical Center, ZA Leiden, the Netherlands
| | - Olaf M Dekkers
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, ZA Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, ZA Leiden, the Netherlands
| | - Wouter R van Furth
- Center for Innovative Pituitary Care and Cranial Base Surgery, Leiden University Medical Center, ZA Leiden, the Netherlands
- University Neurosurgical Centre Holland, Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, ZA Leiden and The Hague, the Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, ZA Leiden, the Netherlands
- Center for Innovative Pituitary Care and Cranial Base Surgery, Leiden University Medical Center, ZA Leiden, the Netherlands
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Fleseriu M, Molitch M, Dreval A, Biermasz NR, Gordon MB, Crosby RD, Ludlam WH, Haviv A, Gilgun-Sherki Y, Mathias SD. Disease and Treatment-Related Burden in Patients With Acromegaly Who Are Biochemically Controlled on Injectable Somatostatin Receptor Ligands. Front Endocrinol (Lausanne) 2021; 12:627711. [PMID: 33790860 PMCID: PMC8006928 DOI: 10.3389/fendo.2021.627711] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/13/2021] [Indexed: 01/17/2023] Open
Abstract
Medical treatment for acromegaly commonly involves receiving intramuscular or deep subcutaneous injections of somatostatin receptor ligands (SRLs) in most patients. In addition to side effects of treatment, acromegaly patients often still experience disease symptoms even when therapy is successful in controlling GH and IGF-1 levels. Symptoms and side effects can negatively impact patients' health-related quality of life. In this study, we examine the disease- and treatment-related burden associated with SRL injections as reported through the use of the Acromegaly Treatment Satisfaction Questionnaire (Acro-TSQ ©) and clinician-reported symptom severity through the Acromegaly Index of Severity (AIS). Patients included in this analysis were enrolled in a randomized phase 3 study, were biochemically-controlled (an IGF-1 < 1.3 × the upper limit of normal [ULN] and average GH < 2.5 ng/ml) and receiving SRL injections for ≥6 months with a stable dose of either long-acting octreotide or lanreotide monotherapy for ≥4 months. The sample (N = 91) was 65% female, 91% Caucasian, with a mean [standard deviation (SD)] age of 53 (1) years. Two-thirds of patients reported that they still experience acromegaly symptoms; 82% of these said they experience symptoms all of the time. Three-fourths experienced gastrointestinal (GI) side effects after injections, and 77% experienced treatment-related injection site reactions (ISRs). Patients commonly reported that these interfered with their daily life, leisure, and work activities. Those with higher symptom severity, as measured by the AIS, scored significantly worse on several Acro-TSQ domains: Symptom Interference, GI Interference, Treatment Satisfaction, and Emotional Reaction. Despite being biochemically controlled with injectable SRLs, most patients reported experiencing acromegaly symptoms that interfere with daily life, leisure, and work. GI side effects and ISRs were also common. This study highlights the significant disease burden that still persists for patients with acromegaly that have achieved biochemical control with the use of injectable SRLs.
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Affiliation(s)
- Maria Fleseriu
- Pituitary Center, Departments of Medicine and Neurological Surgery, Oregon Health and Science University, Portland, OR, United States
- *Correspondence: Maria Fleseriu,
| | - Mark Molitch
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Alexander Dreval
- Department of Clinical Endocrinology, Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - Nienke R. Biermasz
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
| | - Murray B. Gordon
- Allegheny Neuroendocrinology Center, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Ross D. Crosby
- Outcomes Research, Health Outcomes Solutions, Winter Park, FL, United States
- Biomedical Statistics, Sanford Center for Biobehavioral Research, Fargo, ND, United States
| | | | - Asi Haviv
- Clinical Development, Chiasma, Inc., Needham, MA, United States
| | | | - Susan D. Mathias
- Outcomes Research, Health Outcomes Solutions, Winter Park, FL, United States
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Bernabéu I, Fajardo C, Marazuela M, Cordido F, Venegas EM, de Pablos-Velasco P, Maroto GP, Olvera MP, de Paz IP, Carvalho D, Romero C, De la Cruz G, Escolá CÁ. Effectiveness of lanreotide autogel 120 mg at extended dosing intervals for acromegaly. Endocrine 2020; 70:575-583. [PMID: 32725444 PMCID: PMC7674328 DOI: 10.1007/s12020-020-02424-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/13/2020] [Indexed: 12/03/2022]
Abstract
PURPOSE Recent data indicate that extended dosing intervals (EDIs) with lanreotide autogel 120 mg are effective and well-received among patients with acromegaly who have achieved biochemical control with monthly injections of long-acting somatostatin analogues (SSAs). We further evaluated the effectiveness of lanreotide autogel 120 mg delivered at EDIs (>4 weeks) in routine clinical practice. METHODS Cross-sectional, multicentre, observational study conducted to determine the effectiveness-measured by control of serum insulin-like growth factor 1 (IGF-1)-of lanreotide autogel 120 mg at dosing intervals >4 weeks for ≥6 months in selected patients with acromegaly treated in routine clinical practice (NCT02807233). Secondary assessments included control of growth hormone (GH) levels, treatment adherence, patient satisfaction, and quality of life (QoL) using validated questionnaires (EQ-5D, AcroQoL, and TSQM-9). Patients who received radiotherapy within the last 6 months were excluded. RESULTS Among 109 patients evaluated, mean (SD) age was 59.1 (13.2) years. IGF-1 values were normal (mean [SD]: 175.0 [74.5], 95% CI: 160.8 -189.1) in 91.7% of cases and normal in 91.4% of patients without previous radiotherapy treatment (n = 81). GH levels were ≤2.5 and ≤1 ng/mL, respectively, in 80.6% and 58.3%. Most patients were treated either every 5-6 (57.8%) or 7-8 weeks (38.5%), with 2.8% treated greater than every 8 weeks. The mean AcroQoL score was 63.0 (20.1). The mean global treatment satisfaction score (TSQM-9) was 75.1 (16.6). Treatment adherence (defined as no missed injections) was 94.5%. CONCLUSION Lanreotide autogel 120 mg at intervals of >4 weeks provided IGF-1 control in more than 90% of patients with acromegaly. Treatment satisfaction and adherence were good. These findings support use of extended dosing intervals in patients who have achieved good biochemical control with long-acting SSAs.
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Affiliation(s)
- Ignacio Bernabéu
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain.
| | - Carmen Fajardo
- Endocrinology and Nutrition Department, Hospital Universitario de La Ribera, Alzira (Valencia), Spain
| | - Mónica Marazuela
- Endocrinology and Nutrition Department, Hospital Universitario La Princesa, Universidad Autónoma Madrid, Instituto Princesa, Madrid, Spain
| | - Fernando Cordido
- Faculty of Health Sciences and INIBIC, University of A Coruña, and Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Eva María Venegas
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Pedro de Pablos-Velasco
- Endocrinology and Nutrition Department, University of Las Palmas de Gran Canaria. Spain, Las Palmas, Spain
| | - Gonzalo Piedrola Maroto
- Endocrinology and Nutrition Departament Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - María Pilar Olvera
- Endocrinology and Nutrition Departament, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Isabel Pavón de Paz
- Endocrinology and Nutrition Departament, Hospital Universitario de Getafe, Madrid, Spain
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário São João, Faculty of Medicine, i3S, Universidade do Porto, Porto, Portugal
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10
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Samson SL, Nachtigall LB, Fleseriu M, Gordon MB, Bolanowski M, Labadzhyan A, Ur E, Molitch M, Ludlam WH, Patou G, Haviv A, Biermasz N, Giustina A, Trainer PJ, Strasburger CJ, Kennedy L, Melmed S. Maintenance of Acromegaly Control in Patients Switching From Injectable Somatostatin Receptor Ligands to Oral Octreotide. J Clin Endocrinol Metab 2020; 105:dgaa526. [PMID: 32882036 PMCID: PMC7470473 DOI: 10.1210/clinem/dgaa526] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/06/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE The phase 3 CHIASMA OPTIMAL trial (NCT03252353) evaluated efficacy and safety of oral octreotide capsules (OOCs) in patients with acromegaly who previously demonstrated biochemical control while receiving injectable somatostatin receptor ligands (SRLs). METHODS In this double-blind study, patients (N = 56) stratified by prior SRL dose were randomly assigned 1:1 to OOC or placebo for 36 weeks. The primary end point was maintenance of biochemical control at the end of treatment (mean insulin-like growth factor 1 [IGF-1] ≤ 1.0 × upper limit of normal [ULN]; weeks 34 and 36). Time to loss of IGF-1 response and proportion requiring reversion to injectable SRLs were assessed as broader control measures. RESULTS Mean IGF-1 measurements were 0.80 and 0.97 × ULN for OOC and 0.84 and 1.69 × ULN for placebo, at baseline and end of treatment, respectively. Mean growth hormone (GH) changed from 0.66 to 0.60 ng/mL for OOCs and 0.90 to 2.57 ng/mL for placebo. Normalization of IGF-1 levels (≤ 1.0 × ULN) was maintained in 58.2% for OOCs vs 19.4% for placebo (P = .008); GH levels were maintained (< 2.5 ng/mL) in 77.7% for OOC vs 30.4% for placebo (P = .0007). Median time to loss of response (IGF-1 > 1.0 or ≥ 1.3 × ULN definitions) for patients receiving placebo was 16 weeks; for patients receiving OOCs, it was not reached for both definitions during the 36-week trial (P < .0001). Of the patients in the OOC group, 75% completed the trial on oral therapy. The OOC safety profile was consistent with previous SRL experience. CONCLUSIONS OOCs may be an effective therapy for patients with acromegaly who previously were treated with injectable SRLs.
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Affiliation(s)
- Susan L Samson
- Pituitary Center, Baylor St. Luke’s Medical Center, Baylor College of Medicine, Houston, Texas, USA
| | - Lisa B Nachtigall
- Neuroendocrine Unit, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Fleseriu
- Pituitary Center, Oregon Health & Sciences University, Portland, Oregon, USA
| | - Murray B Gordon
- Allegheny Neuroendocrinology Center, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Marek Bolanowski
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland
| | | | - Ehud Ur
- University of British Columbia, Vancouver BC, Canada
| | - Mark Molitch
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Gary Patou
- Chiasma Inc, Needham, Massachusetts, USA
| | - Asi Haviv
- Chiasma Inc, Needham, Massachusetts, USA
| | | | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University, Milan, Italy
| | | | | | | | - Shlomo Melmed
- Cedars-Sinai Medical Center, Los Angeles, California, USA
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Adelman D, Truong Thanh XM, Feuilly M, Houchard A, Cella D. Evaluation of Nurse Preferences Between the Lanreotide Autogel New Syringe and the Octreotide Long-Acting Release Syringe: An International Simulated-Use Study (PRESTO). Adv Ther 2020; 37:1608-1619. [PMID: 32157626 PMCID: PMC7140743 DOI: 10.1007/s12325-020-01255-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Somatostatin analogues are used to treat symptoms and slow tumour progression in patients with neuroendocrine tumours (NETs) and carcinoid syndrome and to reduce hormone secretion and pituitary tumour volume in patients with acromegaly. A new syringe for lanreotide autogel/depot (LAN) was developed following feedback from a human factors study to improve ease of injection compared with previous syringes. PRESTO aimed to assess preferences of nurses between the LAN new syringe and the octreotide long-acting release (LAR) syringe. METHODS PRESTO, a multinational, multicentre, prospective, noninterventional, simulated-use study, enrolled nurses with ≥ 2 years' experience injecting LAN and/or octreotide LAR in patients with NETs and/or acromegaly. Nurses administered injections into pads using the LAN new syringe and octreotide LAR syringe in a randomised sequence. In an anonymous web-based questionnaire, nurses reported their overall preference ('strong' or 'slight'; primary endpoint) and rated and ranked the importance of nine attributes for each syringe (1 [not at all] to 5 [very much]). RESULTS Overall, 90 nurses attended sessions and completed valid questionnaires. Most nurses (97.8%) expressed a preference (85.6% 'strong', 12.2% 'slight') for the LAN new syringe versus the octreotide LAR syringe (P < 0.0001). Attribute performance ratings (1 [not at all] to 5 [very much]) were consistently higher for the LAN new syringe versus the octreotide LAR syringe, with the greatest differences in 'fast administration' and 'confidence the syringe will not be clogged' (mean difference [SD]: 2.6 [1.2] and 2.3 [1.5], respectively; P < 0.0001). The attribute ranked most important was 'confidence the syringe will not be clogged' (24.4%); least important was 'convenience of syringe format, including packaging, from preparation to injection' (34.4%). CONCLUSIONS Nurses preferred the user experience of the LAN new syringe compared with the octreotide LAR syringe, with a particular preference for attributes related to product delivery with the LAN new syringe.
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Affiliation(s)
- Daphne Adelman
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | - Marion Feuilly
- Health Economics and Outcomes Research, Ipsen, Boulogne-Billancourt, France
| | | | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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12
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Fleseriu M, Fogelfeld L, Gordon MB, Sisco J, Colwell HH, Ludlam WH, Haviv A, Mathias SD. Development of a novel patient-reported measure for acromegaly: the Acro-TSQ. Pituitary 2019; 22:581-593. [PMID: 31522359 PMCID: PMC6842345 DOI: 10.1007/s11102-019-00986-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Somatostatin analogs (SSAs) represent a mainstay of medical treatment for acromegaly, currently available as either intramuscular or deep subcutaneous injections. Patient-reported outcomes (PROs) are increasingly common as relevant outcomes in studies of acromegaly and its treatment, but there are no validated PRO measures available that focus on the disease burden and the impact of treatment, specifically designed for use in patients with acromegaly. We sought to develop a new and unique PRO measure, the Acromegaly Treatment Satisfaction Questionnaire (Acro-TSQ). METHODS Concept elicitation (CE) interviews were conducted with acromegaly patients in the United States receiving SSA injections at a stable dose for ≥ 6 months. A questionnaire was drafted based on these interviews; combined CE and cognitive debriefing (CE/CD) interviews were then conducted to confirm the content, clarity, and relevance of the questionnaire. RESULTS Nineteen subjects completed interviews [n = 9 CE, n = 10 CE/CD; n = 15 Lanreotide Depot/Autogel (Somatuline), n = 4 Octreotide LAR (Sandostatin LAR)]. Most subjects responded positively when asked about the effectiveness of their current treatment; however, breakthrough symptoms, injection site reactions, and side effects were commonly reported and had negative impacts on social and emotional well-being and daily activities. All 10 subjects involved in debriefing interviews found the questionnaire to be relevant, easy to complete, and found the response options to be clear. The resulting 26-item Acro-TSQ covers symptoms and symptom control, gastrointestinal side effects and their impact on daily activities, the emotional impact of treatment, convenience and ease of use, and overall satisfaction. CONCLUSIONS The Acro-TSQ is a novel PRO, focused on both disease burden and impact of treatment; it was found to be comprehensive, clear, and relevant for patients with acromegaly receiving injectable SSA treatment.
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Affiliation(s)
- Maria Fleseriu
- Departments of Neurosurgery and Medicine, Northwest Pituitary Center, Oregon Health and Science University, 3303 SW Bond Ave, CH8N, Portland, OR, 97239, USA.
| | - Leon Fogelfeld
- John H. Stroger Jr. Hospital of Cook County, Rush University Medical Center, Chicago, IL, USA
| | - Murray B Gordon
- Allegheny Neuroendocrinology Center, Allegheny General Hospital, Pittsburgh, PA, USA
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Co-Creation of a Lanreotide Autogel/Depot Syringe for the Treatment of Acromegaly and Neuroendocrine Tumours Through Collaborative Human Factor Studies. Adv Ther 2019; 36:3409-3423. [PMID: 31612358 PMCID: PMC6860467 DOI: 10.1007/s12325-019-01112-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Although the previous lanreotide autogel/depot syringe had been well received, feedback indicated that improvements could be made to make it more user-friendly. Additionally, the view that patients should have greater involvement in the research and development process is echoed by the International Neuroendocrine Cancer Alliance. A series of studies aimed to develop and validate a new syringe that works better for patients, caregivers and healthcare professionals (HCPs) by involving these groups at key stages in the development and testing process. METHODS The multicentre, international, human factor studies, consisted of four formative studies and one validation study. The formative studies collected patient, caregiver and HCP feedback on the lanreotide autogel/depot syringe on the market at the time, and on newly designed prototypes. The validation study was conducted to evaluate the final syringe to confirm that it can be used effectively and safely in the intended environment, by the intended user, for the intended purpose. RESULTS Overall, 213 individuals participated in the studies; 145 contributed to the formative studies and 68 to the validation study. The validated new-generation syringe included several important updates compared with the lanreotide autogel/depot syringe currently on the market, including the flanges, which are now larger and have a better grip; the overcap, which is white, ridged, opaque and bigger; the plunger supports and the thermoformed tray. No participant hurt themselves or others during the validation study (although several misuses were reported), and all participants succeeded in delivering a complete dose and activating the safety system. CONCLUSION With collaboration, a new syringe was developed to meet the needs of patients, caregivers and HCPs, whilst ensuring lanreotide was delivered effectively and safely. These studies highlight the importance of involving patients, caregivers and HCPs in clinical evaluation studies to develop medical products that address their concerns and meet their needs. FUNDING Ipsen. Plain language summary available for this article.
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Álvarez-Escolá C, Venegas-Moreno EM, García-Arnés JA, Blanco-Carrera C, Marazuela-Azpiroz M, Gálvez-Moreno MÁ, Menéndez-Torre E, Aller-Pardo J, Salinas-Vert I, Resmini E, Torres-Vela EM, Gonzalo-Redondo MÁ, Vílchez-Joya R, de Miguel-Novoa MP, Halperín-Rabinovich I, Páramo-Fernández C, de la Cruz-Sugranyes G, Houchard A, Picó-Alfonso AM. ACROSTART: A retrospective study of the time to achieve hormonal control with lanreotide Autogel treatment in Spanish patients with acromegaly. ACTA ACUST UNITED AC 2019; 66:320-329. [PMID: 30773338 DOI: 10.1016/j.endinu.2018.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/28/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The ACROSTART study was intended to determine the time to achieve normalization of GH and IGF-I levels in responding patients with acromegaly administered different dosage regimens of lanreotide Autogel (Somatuline® Autogel®). METHODS From March 2013 to October 2013, clinical data from 57 patients from 17 Spanish hospitals with active acromegaly treated with lanreotide for ≥4 months who achieved hormonal control (GH levels <2.5ng/ml and/or normalized IGF-I levels in ≥2 measurements) were analyzed. The primary objective was to determine the time from start of lanreotide treatment to hormonal normalization. RESULTS Median patient age was 64 years, 21 patients were male, 39 patients had undergone surgery, and 14 patients had received radiotherapy. Median hormonal values at start of lanreotide treatment were: GH, 2.6ng/ml; IGF-I, 1.6×ULN. The most common starting dose of lanreotide was 120mg (29 patients). The main initial regimens were 60mg/4 weeks (n=13), 90mg/4 weeks (n=6), 120mg/4 weeks (n=13), 120mg/6 weeks (n=6), and 120mg/8 weeks (n=9). An initial treatment regimen with a long interval (≥6 weeks) was administered in 25 patients. Mean duration of lanreotide treatment was 68 months (7-205). Median time to achieve hormonal control was 4.9 months. Injections were managed without healthcare assistance in 13 patients. Median number of visits to endocrinologists until hormonal control was achieved was 3. Fifty-one patients were "satisfied"/"very satisfied" with treatment and 49 patients did not miss any dose. CONCLUSIONS Real-life treatment with lanreotide Autogel resulted in early hormonal control in responding patients, with high treatment adherence and satisfaction despite disparity in starting doses and dosing intervals.
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Affiliation(s)
| | | | | | - Concepción Blanco-Carrera
- Endocrinology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Mónica Marazuela-Azpiroz
- Endocrinology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Instituto Princesa, Madrid, Spain
| | | | - Edelmiro Menéndez-Torre
- Endocrinology and Nutrition Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Javier Aller-Pardo
- Endocrinology Department, Neuroendocrinology & Endocrine Oncology Unit, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Isabel Salinas-Vert
- Endocrinology and Nutrition Department, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Eugenia Resmini
- Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), IIB-Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Ricardo Vílchez-Joya
- Endocrinology and Nutrition Service, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - María Paz de Miguel-Novoa
- Endocrinology Department, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | | | - Aude Houchard
- Statistics Department, IPSEN PHARMA, Boulogne-Billancourt, France
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Melmed S, Bronstein MD, Chanson P, Klibanski A, Casanueva FF, Wass JAH, Strasburger CJ, Luger A, Clemmons DR, Giustina A. A Consensus Statement on acromegaly therapeutic outcomes. Nat Rev Endocrinol 2018; 14:552-561. [PMID: 30050156 PMCID: PMC7136157 DOI: 10.1038/s41574-018-0058-5] [Citation(s) in RCA: 315] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The 11th Acromegaly Consensus Conference in April 2017 was convened to update recommendations on therapeutic outcomes for patients with acromegaly. Consensus guidelines on the medical management of acromegaly were last published in 2014; since then, new pharmacological agents have been developed and new approaches to treatment sequencing have been considered. Thirty-seven experts in the management of patients with acromegaly reviewed the current literature and assessed changes in drug approvals, clinical practice standards and clinical opinion. They considered current treatment outcome goals with a focus on the impact of current and emerging somatostatin receptor ligands, growth hormone receptor antagonists and dopamine agonists on biochemical, clinical, tumour mass and surgical outcomes. The participants discussed factors that would determine pharmacological choices as well as the proposed place of each agent in the guidelines. We present consensus recommendations highlighting how acromegaly management could be optimized in clinical practice.
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Affiliation(s)
- Shlomo Melmed
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Marcello D Bronstein
- Division of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, Hôpital Bicêtre, Paris, France
- UMR S-1185, Faculté de Médecine Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Paris, France
| | - Anne Klibanski
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Felipe F Casanueva
- Department of Medicine, Santiago de Compostela University, Santiago de Compostela, Spain
| | - John A H Wass
- Department of Endocrinology, Churchill Hospital, Oxford, UK
| | | | - Anton Luger
- Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - David R Clemmons
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Andrea Giustina
- Department of Endocrinology and Metabolism, San Raffaele University Hospital Milan, Milan, Italy
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Salvatori R, Gordon MB, Woodmansee WW, Ioachimescu AG, Carver DW, Mirakhur B, Cox D, Molitch ME. A multicenter, observational study of lanreotide depot/autogel (LAN) in patients with acromegaly in the United States: 2-year experience from the SODA registry. Pituitary 2017; 20:605-618. [PMID: 28741071 DOI: 10.1007/s11102-017-0821-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE This analysis evaluates the 2-year effectiveness and safety of lanreotide depot/autogel (LAN), as well as treatment convenience and acromegaly symptom relief, from the Somatuline® Depot for Acromegaly (SODA) registry, a post-marketing, open-label, observational, multicenter, United States registry study. METHODS Patients with acromegaly treated with LAN were eligible for enrollment. Demographics, LAN dose, extended dosing interval (EDI) (interval of injections ≥42 days), insulin-like growth factor 1 (IGF-1), growth hormone (GH), glycated hemoglobin, adverse events (AEs), injection convenience, and symptom data were collected. RESULTS As of September 29, 2014, 241 patients were enrolled in SODA. IGF-1 levels below age- and gender-adjusted upper normal limit (ULN) were achieved in 71.2% at month (M) 12 and 74.4% at M24; GH ≤2.5 µg/L in 83.3% at M12 and 80.0% at M24; GH <1.0 µg/L in 61.7% at M12 and 61.4% at M24. Both IGF-1 < ULN and GH ≤2.5 µg/L were achieved in 65.0% at M12 and 54.8% at M24; both IGF-1 < ULN and GH < 1.0 µg/L were achieved in 51.7 and 42.9% at M12 and M24, respectively. EDI regimen was 5.0% at baseline and 12.0% at M24. At M24, acromegaly symptoms appeared stable or improved. The most common AE was arthralgia (25.7%). Among 106 serious AEs reported by 42 patients, 10 were deemed related to therapy in 9 patients. At M24, 73.1% of patients rated LAN as convenient. CONCLUSIONS SODA indicates 2-year biochemical control with majority of patients achieving both IGF-1 < ULN and GH ≤2.5 µg/L. LAN was generally well tolerated with no new or unexpected safety signals reported during the observation period. clinicaltrials.gov Clinical Trial Identifier: NCT00686348.
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Affiliation(s)
- Roberto Salvatori
- Division of Endocrinology, Diabetes and Metabolism, and Pituitary Center, Johns Hopkins University, 1830 East Monument Street #333, Baltimore, MD, 21287, USA.
| | - Murray B Gordon
- Allegheny Neuroendocrinology Center, Division of Endocrinology, Allegheny General Hospital, 420 E North Avenue, Suite 205, Pittsburgh, PA, 15212, USA
| | - Whitney W Woodmansee
- Division of Endocrinology, Diabetes and Hypertension, Brigham's and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Adriana G Ioachimescu
- Department of Medicine, Division of Endocrinology, Metabolism and Lipids and Department of Neurosurgery, Emory University School of Medicine, 1365 B Clifton Road, NE, B6209, Atlanta, GA, 30322, USA
| | - Don W Carver
- Ipsen Biopharmaceuticals, Inc. Statistician Consultant, 106 Allen Road, Basking Ridge, NJ, 07920, USA
| | - Beloo Mirakhur
- Medical Affairs, Ipsen Biopharmaceuticals, Inc., 106 Allen Road, Basking Ridge, NJ, 07920, USA
| | - David Cox
- Medical Affairs, Ipsen Biopharmaceuticals, Inc., 106 Allen Road, Basking Ridge, NJ, 07920, USA
| | - Mark E Molitch
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue, Suite 530, Chicago, IL, 60611, USA
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Grasso LFS, Auriemma RS, Pivonello R, Colao A. Somatostatin analogs, cabergoline and pegvisomant: comparing the efficacy of medical treatment for acromegaly. Expert Rev Endocrinol Metab 2017; 12:73-85. [PMID: 30058878 DOI: 10.1080/17446651.2016.1222899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Therapies for acromegaly aim at normalizing hormonal excess and controlling tumor growth . Therapeutic approaches are surgery, pharmacotherapy and radiotherapy. Area covered: This review focuses on the role of medical therapy of acromegaly, comparing the efficacy of somatostatin analogues (SSA), dopamine-agonists (DA) and pegvisomant (PEG), the three available drug classes for treating acromegaly. To clarify the difference in response rates reported in the literature for these therapies, we performed a search for original articles published in PubMed. SSA represent the first-line approach to medical treatment. This therapy is effective in controlling acromegaly in about 40% of patients, however there are great differences in the reported hormonal efficacy of SSA in the different series. In patients partially resistant to SSA, cabergoline can be added when hormonal levels are close to normalization, resulting effective in control IGF-I levels in 43% of patients. In patients with higher hormonal levels PEG is indicated, normalizing IGF-I levels in 79.8% and 80.6% of cases when used in monotherapy or in combination with SSA. Pasireotide, the newly developed SSA multi-ligand receptor, represents a new option in SSA resistant patients. Expert commentary: Medical therapy represents an important therapeutic option resulting safe and effective in controlling acromegaly in a high percentage of patients. The best treatment should be individually tailored for each patient, taking into account sex, age, comorbidities, tumor characteristics and hormonal levels.
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Affiliation(s)
- Ludovica F S Grasso
- a Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia , 'Federico II' University of Naples , Naples , Italy
| | - Renata S Auriemma
- a Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia , 'Federico II' University of Naples , Naples , Italy
| | - Rosario Pivonello
- a Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia , 'Federico II' University of Naples , Naples , Italy
| | - Annamaria Colao
- a Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia , 'Federico II' University of Naples , Naples , Italy
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18
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Jain A, Kunduru KR, Basu A, Mizrahi B, Domb AJ, Khan W. Injectable formulations of poly(lactic acid) and its copolymers in clinical use. Adv Drug Deliv Rev 2016; 107:213-227. [PMID: 27423636 DOI: 10.1016/j.addr.2016.07.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
Abstract
Poly(lactic acid) and its copolymers have revolutionized the field of drug delivery due to their excellent biocompatibility and tunable physico-chemical properties. These copolymers have served the healthcare sector by contributing many products to combat various diseases and for biomedical applications. This article provides a comprehensive overview of clinically used products of poly(lactic acid) and its copolymers. Multi-dimension information covering product approval, formulation aspects and clinical status is described to provide a panoramic overview of each product. Moreover, leading patented technologies and various clinical trials on these products for different applications are included. This review focuses on marketed injectable formulations of PLA and its copolymers.
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19
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Pokuri VK, Fong MK, Iyer R. Octreotide and Lanreotide in Gastroenteropancreatic Neuroendocrine Tumors. Curr Oncol Rep 2016; 18:7. [PMID: 26743514 DOI: 10.1007/s11912-015-0492-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Neuroendocrine tumors are heterogeneous, rare malignancies that arise most commonly in the gastrointestinal tract and pancreas. They often secrete vasoactive substances resulting in carcinoid syndrome and the tumor cells exclusively express somatostatin receptors. Octreotide and lanreotide are the two synthetic somatostatin analogs used for the control of carcinoid symptoms and tumor progression in advanced inoperable disease. Recent pivotal trials (PROMID and CLARINET studies) established their antitumor activity. We discuss the available data to support their use as symptom controlling and antiproliferative agents. This article also reviews the guidelines (National Comprehensive Cancer Network and North American Neuro Endocrine Tumor Society), cost-analysis (suggesting the cost-effectiveness of lanreotide autogel compared to higher doses of octreotide long acting release formulation in refractory patients), and future directions of somatostatin analogs in the management of patients refractory to conventional doses of octreotide and lanreotide.
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Affiliation(s)
- Venkata K Pokuri
- Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Mei Ka Fong
- Department of Pharmacy, Carolinas Healthcare System, Levine Cancer Institute, Charlotte, NC, USA
| | - Renuka Iyer
- Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.
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Khairi S, Sagvand BT, Pulaski-Liebert KJ, Tritos NA, Klibanski A, Nachtigall LB. CLINICAL OUTCOMES AND SELF-REPORTED SYMPTOMS IN PATIENTS WITH ACROMEGALY: AN 8-YEAR FOLLOW-UP OF A LANREOTIDE STUDY. Endocr Pract 2016; 23:56-65. [PMID: 27682353 DOI: 10.4158/ep161439.or] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the proportion of patients with acromegaly who remained on long-term lanreotide depot after completion of an open-label multicenter phase III clinical trial (SALSA: A Multi Center Open Label Study to Assess the Ability of Subjects With Acromegaly or Their Partners to Administer Somatuline Autogel), compare baseline and long-term follow-up symptoms scores, and correlate scores with individual longitudinal clinical outcomes. METHODS Records of all subjects previously enrolled at the Massachusetts General Hospital site of SALSA were reviewed. Those who remained on lanreotide were interviewed and asked to complete a questionnaire that they had filled out in SALSA in 2007 regarding their current symptomatology and injection side effects, as well as to complete the Acromegaly Quality of Life Questionnaire. Furthermore, clinical, biochemical, and radiographic data related to acromegaly and its comorbidities were tracked throughout follow-up. RESULTS Six out of 7 patients chose to remain on lanreotide, and 5 of them continued lanreotide depot through last follow-up, for up to 8 years or in 1 case until death. In all cases, lanreotide remained well tolerated, and insulin-like growth factor-1 levels and pituitary imaging remained well controlled on stable doses. While comorbidities persisted or developed, the self-reported symptom score after up to 8 years of therapy showed a significant decrease in frequency or resolution in symptoms that were reported at baseline. CONCLUSION This study shows a significant decrease in frequency or resolution in self-reported symptoms in well-controlled patients receiving long-term lanreotide therapy. ABBREVIATIONS AcroQoL = Acromegaly Quality of Life Questionnaire GH = growth hormone GI = gastrointestinal IGF-1 = insulin-like growth factor-1 SALSA = A Multi Center Open Label Study to Assess the Ability of Subjects With Acromegaly or Their Partners to Administer Somatuline Autogel.
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Sagvand BT, Khairi S, Haghshenas A, Swearingen B, Tritos NA, Miller KK, Klibanski A, Nachtigall LB. Monotherapy with lanreotide depot for acromegaly: long-term clinical experience in a pituitary center. Pituitary 2016; 19:437-47. [PMID: 27155600 DOI: 10.1007/s11102-016-0724-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE Long-acting somatostatin analogs are one of the main classes of medical therapy used for acromegaly and most patients require ongoing treatment. Few studies have evaluated the long-term efficacy and safety of lanreotide depot beyond 2 years. The goal of this study was to provide a long-term longitudinal assessment of efficacy and safety of lanreotide depot in lanreotide responders compared to a surgically cured control group. METHODS In this retrospective longitudinal case-control study, patients with acromegaly receiving lanreotide depot monotherapy continuously for at least 24 months (N = 24) and surgically cured patients (N = 39) were compared. Serum IGF-1, pituitary MRIs, lanreotide dose, co-morbidities and adverse effects were assessed longitudinally. RESULTS In the lanreotide group, IGF-1 remained normal and unchanged over 6 years; comparable to the surgery only group. There was no difference in prevalence of normal IGF-1 between the lanreotide and surgery only groups at 6 months (100 vs. 97 %), 6 years (89 vs. 90 %) and at last follow-up (96 vs. 92 %). Tumor size remained stable (79 %) or decreased (21 %) in the lanreotide group. In the surgery only group, tumor size remained unchanged in all patients. Hemoglobin A1C did not differ between lanreotide and surgery only groups (baseline 5.8 vs. 6.1 %; last follow-up 6.0 vs. 5.7 %). Two (8 %) of the lanreotide and none of the surgery only group developed new diabetes mellitus. CONCLUSION Lanreotide depot maintains normalization of IGF-1 in 89 % of responders after 6 years, comparable to surgically cured controls, and controlled tumor size in all without significant adverse effects.
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Affiliation(s)
- Babak Torabi Sagvand
- Neuroendocrine Unit, Neuroendocrine Clinical Center, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Place, Suite 112, Boston, MA, 02114, USA
| | - Shafaq Khairi
- Neuroendocrine Unit, Neuroendocrine Clinical Center, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Place, Suite 112, Boston, MA, 02114, USA
| | - Arezoo Haghshenas
- Neuroendocrine Unit, Neuroendocrine Clinical Center, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Place, Suite 112, Boston, MA, 02114, USA
| | - Brooke Swearingen
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Nicholas A Tritos
- Neuroendocrine Unit, Neuroendocrine Clinical Center, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Place, Suite 112, Boston, MA, 02114, USA
| | - Karen K Miller
- Neuroendocrine Unit, Neuroendocrine Clinical Center, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Place, Suite 112, Boston, MA, 02114, USA
| | - Anne Klibanski
- Neuroendocrine Unit, Neuroendocrine Clinical Center, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Place, Suite 112, Boston, MA, 02114, USA
| | - Lisa B Nachtigall
- Neuroendocrine Unit, Neuroendocrine Clinical Center, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Place, Suite 112, Boston, MA, 02114, USA.
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Follin C, Karlsson S. Attitudes and preferences in patients with acromegaly on long-term treatment with somatostatin analogues. Endocr Connect 2016; 5:167-73. [PMID: 27458240 PMCID: PMC5308196 DOI: 10.1530/ec-16-0038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 07/21/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Patients with acromegaly can be treated with surgery, medical therapy and/or radiation therapy. For the patients not being cured with surgery, treatment with somatostatin analogues (SSAs) is the primary therapy. SSA can be taken by self- or partner-administered injections in addition to being given by a nurse at a clinic. The aim was to assess if patients with acromegaly prefer self-injections and to investigate their attitudes towards long-term medical therapy. METHOD All patients in the southern medical region of Sweden with a diagnosis of acromegaly and treated with SSA were eligible for the study (n = 24). The study is based on a questionnaire asking about the patients' attitudes and preferences for injections with SSA, including their attitudes towards self-injection with SSA. RESULTS The patients' (23 included) median age was 68.5 years and the patients had been treated with SSA for 13 (1-38) years. One patient was currently self-injecting. All of the other patients were receiving injections from a nurse at a clinic. Three patients preferred self-injections, one preferred partner injections and 19 patients did not prefer self- or partner injections. The most frequent arguments to not preferring self-injections were 'feeling more secure with an educated nurse' and 'preferring regular contact with a specialised nurse'. CONCLUSION Patients with acromegaly prefer regular contact with the endocrine team to the independence offered by self-injections. These findings might mirror the patients' desires for continuity and safety. We need to address patients' concerns regarding injections with SSA and support them in their choices.
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Affiliation(s)
- Cecilia Follin
- Department of EndocrinologySkåne University Hospital, Lund, Sweden
| | - Sven Karlsson
- Department of EndocrinologySkåne University Hospital, Lund, Sweden
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Colao A, Auriemma RS, Pivonello R, Kasuki L, Gadelha MR. Interpreting biochemical control response rates with first-generation somatostatin analogues in acromegaly. Pituitary 2016; 19:235-47. [PMID: 26519143 PMCID: PMC4858561 DOI: 10.1007/s11102-015-0684-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
CONTEXT The somatostatin analogues octreotide LAR and lanreotide Autogel have been evaluated for the treatment of acromegaly in numerous clinical trials, with considerable heterogeneity in reported biochemical response rates. This review examines and attempts to account for these differences in response rates reported in the literature. EVIDENCE ACQUISITION PubMed was searched for English-language studies of a minimum duration of 24 weeks that evaluated ≥10 patients with acromegaly treated with octreotide LAR or lanreotide Autogel from 1990 to March 2015 and reported GH and/or IGF-1 data as the primary objective of the study. EVIDENCE SYNTHESIS Of the 190 clinical trials found, 18 octreotide LAR and 15 lanreotide Autogel studies fulfilled the criteria for analysis. It is evident from the protocols of these studies that multiple factors are capable of impacting on reported response rates. Prospective studies reporting an intention-to-treat analysis that evaluated medically naïve patients and used the composite endpoint of both GH and IGF-1 control were associated with lower response rates. The use of non-composite biochemical control endpoints, heterogeneous patient populations, analyses that exclude treatment non-responders, assay variability and prior responsiveness to medical therapy are just a few of the factors identified that likely contribute to higher success rates. CONCLUSIONS The wide range of reported response rates with somatostatin analogues may be confusing and could lead to misinterpretation by both the patient and the physician in certain situations. Understanding the factors that potentially drive the variation in response rates should allow clinicians to better gauge treatment expectations in specific patients.
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Affiliation(s)
- Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Via S Pansini 5, 80131, Naples, Italy.
| | - Renata S Auriemma
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Via S Pansini 5, 80131, Naples, Italy
| | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Via S Pansini 5, 80131, Naples, Italy
| | - Leandro Kasuki
- Endocrine Unit, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mônica R Gadelha
- Endocrine Unit, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Strasburger CJ, Karavitaki N, Störmann S, Trainer PJ, Kreitschmann-Andermahr I, Droste M, Korbonits M, Feldmann B, Zopf K, Sanderson VF, Schwicker D, Gelbaum D, Haviv A, Bidlingmaier M, Biermasz NR. Patient-reported outcomes of parenteral somatostatin analogue injections in 195 patients with acromegaly. Eur J Endocrinol 2016; 174:355-62. [PMID: 26744896 PMCID: PMC4722610 DOI: 10.1530/eje-15-1042] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 12/17/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Long-acting somatostatin analogues delivered parenterally are the most widely used medical treatment in acromegaly. This patient-reported outcomes survey was designed to assess the impact of chronic injections on subjects with acromegaly. METHODS The survey was conducted in nine pituitary centres in Germany, UK and The Netherlands. The questionnaire was developed by endocrinologists and covered aspects of acromegaly symptoms, injection-related manifestations, emotional and daily life impact, treatment satisfaction and unmet medical needs. RESULTS In total, 195 patients participated, of which 112 (57%) were on octreotide (Sandostatin LAR) and 83 (43%) on lanreotide (Somatuline Depot). The majority (>70%) of patients reported acromegaly symptoms despite treatment. A total of 52% of patients reported that their symptoms worsen towards the end of the dosing interval. Administration site pain lasting up to a week following injection was the most frequently reported injection-related symptom (70% of patients). Other injection site reactions included nodules (38%), swelling (28%), bruising (16%), scar tissue (8%) and inflammation (7%). Injection burden was similar between octreotide and lanreotide. Only a minority of patients received injections at home (17%) and 5% were self-injecting. Over a third of patients indicated a feeling of loss of independence due to the injections, and 16% reported repeated work loss days. Despite the physical, emotional and daily life impact of injections, patients were satisfied with their treatment, yet reported that modifications that would offer major improvement over current care would be 'avoiding injections' and 'better symptom control'. CONCLUSION Lifelong injections of long-acting somatostatin analogues have significant burden on the functioning, well-being and daily lives of patients with acromegaly.
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Affiliation(s)
- Christian J Strasburger
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Niki Karavitaki
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Sylvère Störmann
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Peter J Trainer
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Ilonka Kreitschmann-Andermahr
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Michael Droste
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Márta Korbonits
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Berit Feldmann
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Kathrin Zopf
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Violet Fazal Sanderson
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - David Schwicker
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Dana Gelbaum
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Asi Haviv
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Martin Bidlingmaier
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Nienke R Biermasz
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
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The Modern Criteria for Medical Management of Acromegaly. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2016; 138:63-83. [DOI: 10.1016/bs.pmbts.2015.10.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Alvarez-Escola C, Cárdenas-Salas JJ, Pelegrina B, Sanz-Valtierra A, Lecumberri B. Severe scalp hair loss in a female patient with acromegaly treated with lanreotide autogel after unsuccessful surgery. Clin Case Rep 2015; 3:945-8. [PMID: 26576278 PMCID: PMC4641480 DOI: 10.1002/ccr3.388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/16/2015] [Accepted: 08/13/2015] [Indexed: 11/20/2022] Open
Abstract
Scalp hair loss is an underreported adverse event of somatostatin analogs therapy that in severe cases may require treatment withdrawal. It can be related to an acute decrease in GH/IGF-1 levels, but a direct effect cannot be ruled out.
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Affiliation(s)
- Cristina Alvarez-Escola
- Endocrinology Department, La Paz University Hospital Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Jersy J Cárdenas-Salas
- Endocrinology Department, La Paz University Hospital Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Beatriz Pelegrina
- Endocrinology Department, La Paz University Hospital Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Angel Sanz-Valtierra
- Endocrinology Department, La Paz University Hospital Paseo de La Castellana 261, 28046 Madrid, Spain
| | - Beatriz Lecumberri
- Endocrinology Department, La Paz University Hospital Paseo de La Castellana 261, 28046 Madrid, Spain
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Neggers SJCMM, Pronin V, Balcere I, Lee MK, Rozhinskaya L, Bronstein MD, Gadelha MR, Maisonobe P, Sert C, van der Lely AJ. Lanreotide Autogel 120 mg at extended dosing intervals in patients with acromegaly biochemically controlled with octreotide LAR: the LEAD study. Eur J Endocrinol 2015; 173:313-23. [PMID: 26047625 PMCID: PMC4544680 DOI: 10.1530/eje-15-0215] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/05/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate extended dosing intervals (EDIs) with lanreotide Autogel 120 mg in patients with acromegaly previously biochemically controlled with octreotide LAR 10 or 20 mg. DESIGN AND METHODS Patients with acromegaly had received octreotide LAR 10 or 20 mg/4 weeks for ≥ 6 months and had normal IGF1 levels. Lanreotide Autogel 120 mg was administered every 6 weeks for 24 weeks (phase 1); depending on week-24 IGF1 levels, treatment was then administered every 4, 6 or 8 weeks for a further 24 weeks (phase 2). Hormone levels, patient-reported outcomes and adverse events were assessed. PRIMARY ENDPOINT proportion of patients on 6- or 8-week EDIs with normal IGF1 levels at week 48 (study end). RESULTS 107/124 patients completed the study (15 withdrew from phase 1 and two from phase 2). Of 124 patients enrolled, 77.4% were allocated to 6- or 8-week EDIs in phase 2 and 75.8% (95% CI: 68.3-83.3) had normal IGF1 levels at week 48 with the EDI (primary analysis). A total of 88.7% (83.1-94.3) had normal IGF1 levels after 24 weeks with 6-weekly dosing. GH levels were ≤ 2.5 μg/l in > 90% of patients after 24 and 48 weeks. Patient preferences for lanreotide Autogel 120 mg every 4, 6 or 8 weeks over octreotide LAR every 4 weeks were high. CONCLUSIONS Patients with acromegaly achieving biochemical control with octreotide LAR 10 or 20 mg/4 weeks are possible candidates for lanreotide Autogel 120 mg EDIs. EDIs are effective and well received among such patients.
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Affiliation(s)
- Sebastian J C M M Neggers
- Department of EndocrinologyErasmus Medical Center, Rotterdam, NetherlandsDepartment of EndocrinologyI.M. Sechenov First Moscow State Medical University, Moscow, Russian FederationDepartment of EndocrinologyPauls Stradins Clinical University Hospital, Riga, LatviaDivision of Endocrinology and MetabolismSamsung Medical Center, Sungkyunkwan University, Seoul, Republic of KoreaDepartment of Neuroendocrinology and Bone DiseasesNational Endocrinology Research Centre, Moscow, Russian FederationNeuroendocrine UnitDivision of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, BrazilEndocrine SectionHospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, BrazilIpsen Boulogne-BillancourtFrance
| | - Vyacheslav Pronin
- Department of EndocrinologyErasmus Medical Center, Rotterdam, NetherlandsDepartment of EndocrinologyI.M. Sechenov First Moscow State Medical University, Moscow, Russian FederationDepartment of EndocrinologyPauls Stradins Clinical University Hospital, Riga, LatviaDivision of Endocrinology and MetabolismSamsung Medical Center, Sungkyunkwan University, Seoul, Republic of KoreaDepartment of Neuroendocrinology and Bone DiseasesNational Endocrinology Research Centre, Moscow, Russian FederationNeuroendocrine UnitDivision of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, BrazilEndocrine SectionHospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, BrazilIpsen Boulogne-BillancourtFrance
| | - Inga Balcere
- Department of EndocrinologyErasmus Medical Center, Rotterdam, NetherlandsDepartment of EndocrinologyI.M. Sechenov First Moscow State Medical University, Moscow, Russian FederationDepartment of EndocrinologyPauls Stradins Clinical University Hospital, Riga, LatviaDivision of Endocrinology and MetabolismSamsung Medical Center, Sungkyunkwan University, Seoul, Republic of KoreaDepartment of Neuroendocrinology and Bone DiseasesNational Endocrinology Research Centre, Moscow, Russian FederationNeuroendocrine UnitDivision of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, BrazilEndocrine SectionHospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, BrazilIpsen Boulogne-BillancourtFrance
| | - Moon-Kyu Lee
- Department of EndocrinologyErasmus Medical Center, Rotterdam, NetherlandsDepartment of EndocrinologyI.M. Sechenov First Moscow State Medical University, Moscow, Russian FederationDepartment of EndocrinologyPauls Stradins Clinical University Hospital, Riga, LatviaDivision of Endocrinology and MetabolismSamsung Medical Center, Sungkyunkwan University, Seoul, Republic of KoreaDepartment of Neuroendocrinology and Bone DiseasesNational Endocrinology Research Centre, Moscow, Russian FederationNeuroendocrine UnitDivision of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, BrazilEndocrine SectionHospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, BrazilIpsen Boulogne-BillancourtFrance
| | - Liudmila Rozhinskaya
- Department of EndocrinologyErasmus Medical Center, Rotterdam, NetherlandsDepartment of EndocrinologyI.M. Sechenov First Moscow State Medical University, Moscow, Russian FederationDepartment of EndocrinologyPauls Stradins Clinical University Hospital, Riga, LatviaDivision of Endocrinology and MetabolismSamsung Medical Center, Sungkyunkwan University, Seoul, Republic of KoreaDepartment of Neuroendocrinology and Bone DiseasesNational Endocrinology Research Centre, Moscow, Russian FederationNeuroendocrine UnitDivision of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, BrazilEndocrine SectionHospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, BrazilIpsen Boulogne-BillancourtFrance
| | - Marcello D Bronstein
- Department of EndocrinologyErasmus Medical Center, Rotterdam, NetherlandsDepartment of EndocrinologyI.M. Sechenov First Moscow State Medical University, Moscow, Russian FederationDepartment of EndocrinologyPauls Stradins Clinical University Hospital, Riga, LatviaDivision of Endocrinology and MetabolismSamsung Medical Center, Sungkyunkwan University, Seoul, Republic of KoreaDepartment of Neuroendocrinology and Bone DiseasesNational Endocrinology Research Centre, Moscow, Russian FederationNeuroendocrine UnitDivision of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, BrazilEndocrine SectionHospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, BrazilIpsen Boulogne-BillancourtFrance
| | - Mônica R Gadelha
- Department of EndocrinologyErasmus Medical Center, Rotterdam, NetherlandsDepartment of EndocrinologyI.M. Sechenov First Moscow State Medical University, Moscow, Russian FederationDepartment of EndocrinologyPauls Stradins Clinical University Hospital, Riga, LatviaDivision of Endocrinology and MetabolismSamsung Medical Center, Sungkyunkwan University, Seoul, Republic of KoreaDepartment of Neuroendocrinology and Bone DiseasesNational Endocrinology Research Centre, Moscow, Russian FederationNeuroendocrine UnitDivision of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, BrazilEndocrine SectionHospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, BrazilIpsen Boulogne-BillancourtFrance
| | - Pascal Maisonobe
- Department of EndocrinologyErasmus Medical Center, Rotterdam, NetherlandsDepartment of EndocrinologyI.M. Sechenov First Moscow State Medical University, Moscow, Russian FederationDepartment of EndocrinologyPauls Stradins Clinical University Hospital, Riga, LatviaDivision of Endocrinology and MetabolismSamsung Medical Center, Sungkyunkwan University, Seoul, Republic of KoreaDepartment of Neuroendocrinology and Bone DiseasesNational Endocrinology Research Centre, Moscow, Russian FederationNeuroendocrine UnitDivision of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, BrazilEndocrine SectionHospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, BrazilIpsen Boulogne-BillancourtFrance
| | - Caroline Sert
- Department of EndocrinologyErasmus Medical Center, Rotterdam, NetherlandsDepartment of EndocrinologyI.M. Sechenov First Moscow State Medical University, Moscow, Russian FederationDepartment of EndocrinologyPauls Stradins Clinical University Hospital, Riga, LatviaDivision of Endocrinology and MetabolismSamsung Medical Center, Sungkyunkwan University, Seoul, Republic of KoreaDepartment of Neuroendocrinology and Bone DiseasesNational Endocrinology Research Centre, Moscow, Russian FederationNeuroendocrine UnitDivision of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, BrazilEndocrine SectionHospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, BrazilIpsen Boulogne-BillancourtFrance
| | - Aart Jan van der Lely
- Department of EndocrinologyErasmus Medical Center, Rotterdam, NetherlandsDepartment of EndocrinologyI.M. Sechenov First Moscow State Medical University, Moscow, Russian FederationDepartment of EndocrinologyPauls Stradins Clinical University Hospital, Riga, LatviaDivision of Endocrinology and MetabolismSamsung Medical Center, Sungkyunkwan University, Seoul, Republic of KoreaDepartment of Neuroendocrinology and Bone DiseasesNational Endocrinology Research Centre, Moscow, Russian FederationNeuroendocrine UnitDivision of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, BrazilEndocrine SectionHospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, BrazilIpsen Boulogne-BillancourtFrance
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Grasso LFS, Auriemma RS, Pivonello R, Colao A. Adverse events associated with somatostatin analogs in acromegaly. Expert Opin Drug Saf 2015; 14:1213-26. [DOI: 10.1517/14740338.2015.1059817] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Plunkett C, Barkan AL. The care continuum in acromegaly: how patients, nurses, and physicians can collaborate for successful treatment experiences. Patient Prefer Adherence 2015; 9:1093-9. [PMID: 26251582 PMCID: PMC4524590 DOI: 10.2147/ppa.s84887] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Patients with acromegaly (a condition of chronic growth hormone hypersecretion by a pituitary adenoma) often require pharmacological treatment. Somatostatin analogs (SSAs) such as pasireotide, lanreotide, and octreotide are frequently used as first-line medical therapy. As SSAs are delivered by regular subcutaneous or intramuscular injections, they can result in injection-related pain or anxiety and can be challenging to fit into patients' lifestyles. When combined with the prolonged, debilitating psychological complications associated with acromegaly, these administration challenges can negatively impact compliance, adherence, and quality of life. Proactively managing patients' expectations and providing appropriate, timely guidance are crucial for maximizing adherence, and ultimately, optimizing the treatment experience. As part of ongoing clinical research since 1997, our team at the University of Michigan has used SSAs to treat 30 patients with acromegaly. Based on our clinical experiences with multiple SSA administration regimens (long-acting intramuscular, long-acting deep subcutaneous, and twice-daily subcutaneous), we generated a dialog map that guides health care professionals through the many sensitive and complex patient communication issues surrounding this treatment process. Beginning with diagnosis, the dialog map includes discussion of treatment options, instruction on proper drug administration technique, and ensuring of appropriate follow-up care. At each step, we provide talking points that address the following: the patients' clinical situation; their geographic, economic, and psychological concerns; and their inclination to communicate with clinicians. We have found that involving patients, nurses, and physicians as equal partners in the treatment process optimizes treatment initiation, adherence, and persistence in acromegaly. By encouraging collaboration across the care continuum, this dialog map can facilitate identification of the treatment plan that is most likely to yield the best possible outcome.
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Affiliation(s)
- Cynthia Plunkett
- Division of Endocrinology, University of Michigan Medical Center, Ann Arbor, MI, USA
- Correspondence: Cynthia Plunkett, MEND Clinical Research Center, 24 Frank Lloyd Wright, Lobby G/Suite 1500, Ann Arbor, MI 48105, USA, Tel +1 734 936 8065, Fax +1 734 763 6171, Email
| | - Ariel L Barkan
- Division of Endocrinology, University of Michigan Medical Center, Ann Arbor, MI, USA
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Abu Dabrh AM, Mohammed K, Asi N, Farah WH, Wang Z, Farah MH, Prokop LJ, Katznelson L, Murad MH. Surgical interventions and medical treatments in treatment-naïve patients with acromegaly: systematic review and meta-analysis. J Clin Endocrinol Metab 2014; 99:4003-14. [PMID: 25356809 PMCID: PMC5393500 DOI: 10.1210/jc.2014-2900] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Acromegaly is usually treated with surgery as a first-line treatment, although medical therapy has also been used as an alternative primary treatment. OBJECTIVE We conducted a systematic review and meta-analysis to synthesize the existing evidence comparing these two approaches in treatment-naïve patients with acromegaly. DATA SOURCES This study performed a comprehensive search in multiple databases, including Medline, EMBASE, and Scopus from early inception through April 2014. STUDY SELECTION The study used original controlled and uncontrolled studies that enrolled patients with acromegaly to receive either surgical treatment or medical treatment as their first-line treatment. DATA EXTRACTION Reviewers extracted data independently and in duplicates. Because of the noncomparative nature of the available studies, we modified the Newcastle-Ottawa Scale to assess the quality of included studies. Outcomes evaluated were biochemical remission and change in IGF-1 or GH levels. We pooled outcomes using the random-effects model. DATA SYNTHESIS The final search yielded 35 studies enrolling 2629 patients. Studies were noncomparative series with a follow-up range of 6-360 months. Compared with medical therapy, surgery was associated with a higher remission rate (67% vs 45%; P = .02). Surgery had higher remission rates at longer follow-up periods (≥ 24 mo) (66% vs 44%; P = .04) but not the shorter follow-up periods (≤ 6 mo) (37% vs 26%; P = .22) [Corrected].Surgery had higher remission rates in the follow-up levels of GH (65% vs 46%; P = .05). In one study, the IGF-1 level was reduced more with surgery compared with medical treatment (-731 μg/L vs -251 μg/L; P = .04). Studies in which surgery was performed by a single operator reported a higher remission rate than those with multiple operators (71% vs 47%; P = .002). CONCLUSIONS Surgery may be associated with higher remission rate; however, the confidence in such evidence is very low due to the noncomparative nature of the studies, high heterogeneity, and imprecision.
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Affiliation(s)
- Abd Moain Abu Dabrh
- Division of Preventive, Occupational, and Aerospace Medicine (A.M.A.D., M.H.M.), Mayo Clinic, Rochester Minnesota 55905, Knowledge and Evaluation Research Unit (A.M.A.D., K.M., N.A., W.H.F., Z.W., M.H.F., M.H.M.), Center for the Science of Health Care Delivery, Mayo Clinic, Rochester Minnesota 55905, Library Public Services (L.J.P.), Mayo Clinic, Rochester Minnesota 55905, and Department of Medicine, Division of Endocrinology and Metabolism and Department of Neurosurgery (L.K.), Stanford University School of Medicine, Stanford, California 94305
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Kyriakakis N, Chau V, Lynch J, Orme SM, Murray RD. Lanreotide autogel in acromegaly - a decade on. Expert Opin Pharmacother 2014; 15:2681-92. [PMID: 25307803 DOI: 10.1517/14656566.2014.970173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The novel formulation of lanreotide, lanreotide (LAN) autogel (ATG), has been available in Europe since 2001 and USA from 2006 for the treatment of acromegaly. It is one of only two clinically available somatostatin analogs available for use in acromegaly. Data relating to the use of ATG in acromegaly, specifically relating to comparison to octreotide (OCT) LAR and patient acceptability and preference, have been slow to accumulate. AREAS COVERED We performed a comprehensive review of the original literature relating to development, pharmacokinetics, acceptability and clinical efficacy of ATG. EXPERT OPINION LAN ATG is a novel formulation of LAN consequent on self-assembly of nanotubules in water. Diffusion between molecules within the nanotubules and surrounding tissue fluid in vivo leads to pseudo first-order pharmacokinetics. Efficacy is equivalent to the alternate long-acting somatostatin analog, OCT LAR, normalizing growth hormone and IGF-I levels in around 60 and 50% respectively. Control of tumor growth is observed in over 95% of patients, with 64% seeing a clinically significant reduction in tumor size. ATG is provided in a prefilled syringe for deep subcutaneous injection, allowing self-injection, and may be administered up to 8 weeks greatly improving convenience for the patient. The data strongly support consideration of ATG as the medical therapy of choice for patients with acromegaly.
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Affiliation(s)
- Nikolaos Kyriakakis
- St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds Centre for Diabetes and Endocrinology, Department of Endocrinology , Beckett Street, Leeds LS9 7TF , UK +44 0 113 206 4578 ; +44 0 113 206 5065 ;
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Burness CB, Dhillon S, Keam SJ. Lanreotide Autogel®: A Review of its Use in the Treatment of Patients with Acromegaly. Drugs 2014; 74:1673-91. [DOI: 10.1007/s40265-014-0283-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Giustina A, Mazziotti G, Maffezzoni F, Amoroso V, Berruti A. Investigational drugs targeting somatostatin receptors for treatment of acromegaly and neuroendocrine tumors. Expert Opin Investig Drugs 2014; 23:1619-35. [DOI: 10.1517/13543784.2014.942728] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Giustina A, Chanson P, Kleinberg D, Bronstein MD, Clemmons DR, Klibanski A, van der Lely AJ, Strasburger CJ, Lamberts SW, Ho KKY, Casanueva FF, Melmed S. Expert consensus document: A consensus on the medical treatment of acromegaly. Nat Rev Endocrinol 2014; 10:243-8. [PMID: 24566817 DOI: 10.1038/nrendo.2014.21] [Citation(s) in RCA: 256] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In March 2013, the Acromegaly Consensus Group met to revise and update guidelines for the medical treatment of acromegaly. The meeting comprised experts skilled in the medical management of acromegaly. The group considered treatment goals covering biochemical, clinical and tumour volume outcomes, and the place in guidelines of somatostatin receptor ligands, growth hormone receptor antagonists and dopamine agonists, and alternative modalities for treatment including combination therapy and novel treatments. This document represents the conclusions of the workshop consensus.
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Affiliation(s)
- Andrea Giustina
- Chair of Endocrinology, University of Brescia, via Biseo 17, 25100 Brescia, Italy
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Service d'Endocrinologie et des Maladies de la Reproduction, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Paris, F 94275, France
| | - David Kleinberg
- Neuroendocrine Unit, New York University School of Medicine, Department of Veterans Affairs Medical Centre, 423 East 23rd Street, Room 16043W, New York, NY 10010, USA
| | - Marcello D Bronstein
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School, Avenue Dr. Eneas de Carvalho, 255, 7° Andar, Sala 7037, São Paulo, CEP 05403 000, Brazil
| | - David R Clemmons
- Department of Medicine, University of North Carolina, CB# 7170, 8024 Burnett-Womack, Chapel Hill, NC 27599, USA
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Aart J van der Lely
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | | | - Steven W Lamberts
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Ken K Y Ho
- Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, QLD 4102, Australia
| | - Felipe F Casanueva
- Santiago de Compostela University and CIBERobn, Santiago de Compostela, E-15780, Spain
| | - Shlomo Melmed
- Department of Medicine, Cedars-Sinai Medical Center, Room 2015, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
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Salvatori R, Woodmansee WW, Molitch M, Gordon MB, Lomax KG. Lanreotide extended-release aqueous-gel formulation, injected by patient, partner or healthcare provider in patients with acromegaly in the United States: 1-year data from the SODA registry. Pituitary 2014; 17:13-21. [PMID: 23314980 PMCID: PMC3895214 DOI: 10.1007/s11102-012-0460-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Lanreotide depot (LD; commercial name Somatuline(®) Depot) is an injectable, extended-release formulation of the synthetic somatostatin analog (SSA) lanreotide. In recent clinical trials, LD was found to be suitable for self or partner administration, avoiding the need to travel to a medical facility. The Somatuline(®) Depot for Acromegaly (SODA) study is an ongoing, multicenter, observational study in the US investigating the efficacy, safety, convenience and symptom relief provided by LD in patients with acromegaly. Sub-analyses explore outcomes according to who administered the injection: patient, partner, healthcare provider (HCP) or a combination. Data reported here reflect one year of patient experience. Patients are eligible for inclusion if they have a diagnosis of acromegaly, are treated with LD and can give signed informed consent. Baseline data include patient demographics, previous acromegaly treatment and investigations, GH and IGF-I levels, LD dose and dose adjustment frequency. Symptom frequency, injection pain and treatment convenience are assessed using patient-reported questionnaires. As of 18 April 2012, 166 patients had enrolled in SODA. Most (72 %) achieved normal IGF-I levels after 12 months of LD treatment. Disease control was similar in self or partner injectors and in patients who received injections from their HCP, although self or partner injecting was deemed more convenient. LD was well-tolerated irrespective of who performed the injection. Self injection led to more injection-site reactions, but this did not increase the rate of treatment interruption. Acromegaly symptoms remained stable. Biochemical, safety and convenience data support the clinical validity of injecting LD at home.
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Affiliation(s)
- Roberto Salvatori
- Division of Endocrinology, Johns Hopkins University, 1830 East Monument Street #333, Baltimore, MD, 21287, USA,
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Abstract
BACKGROUND Health-related quality of life (QoL) is severely impaired in acromegaly due to the physical and psychological consequences of the disease. Pharmacological and surgical treatments, when available, can improve QoL and life expectancy. CASE DESCRIPTION A 34-year-old male with uncontrolled acromegaly due to a large and invasive macroadenoma, which could not be resected by transsphenoidal surgery. Over 9 years, he had limited access to pharmacological interventions and persisted with clinically and biochemically active disease, with severe co-morbidities and a poor QoL, which eventually lead to a premature sudden death. CONCLUSION This case highlights the impact that active acromegaly has when treatment resources are limited. We review the factors contributing to poor QoL in this disease, with special reference to the Latin American scenario.
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Affiliation(s)
- Mirtha Guitelman
- División Endocrinología, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Alin Abreu
- Endocrinología, Centro Médico Imbanaco, Cali, Colombia
| | | | - Moisés Mercado
- Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Endocrine Service, Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Aristóteles 68 Polanco, 11560 Mexico City, Mexico
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Abstract
INTRODUCTION Acromegaly is a rare disease that severely impacts patients' health all the while, being a slowly progressing illness. In the past decades, advancements in treatment modalities, especially development of new drugs, as well as focused guidelines has improved management of acromegaly. Still, many patients are considered not sufficiently treated and there remains an ongoing need for further development. AREAS COVERED This article reviews new medical treatments currently under clinical investigation (such as pasireotide, oral octreotide and somatoprim) and under experimental development (such as octreotide implants, CAM2029 and ATL-1103). EXPERT OPINION As it seems unlikely that one single agent may achieve cure in 100% of cases, there is an urgent need for new agents that help patients where current medication fails. Imperatively, this means we have to improve our understanding of the underlying pathogenetic and molecular mechanisms.
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Affiliation(s)
- Sylvère Störmann
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV , Ziemssenstr. 1, 80336 München , Germany +49 0 89 5160 2111 ; +49 0 89 5160 2194 ;
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Jallad RS, Bronstein MD. The place of medical treatment of acromegaly: current status and perspectives. Expert Opin Pharmacother 2013; 14:1001-15. [PMID: 23600991 DOI: 10.1517/14656566.2013.784744] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Acromegaly is characterized by elevated growth hormone (GH) and insulin-like growth factor-I (IGF-I) levels and by progressive somatic disfigurement and systemic manifestations, which lead to a mortality rate higher than the general population. Therefore, diagnosis and properly treatment should be performed as soon as possible. AREAS COVERED This article focuses on the state of the art of acromegaly medical treatment. Somatostatin analogs, dopamine agonists and GH receptor antagonist were reviewed. Somatostatin analogs, the first-choice pharmacotherapy, can be used as primary or pre-operative treatment or as secondary therapy after failed surgery. Dopamine agonists have been used in patients with slightly elevated hormone levels and/or mixed GH/prolactin adenomas. Pegvisomant is indicated for resistant to somatostatin analogs/dopamine agonists. Combined treatment is also an option for resistant cases. Other non-conventional therapies and perspectives of treatment were also been discussed. EXPERT OPINION The control of disease activity in acromegaly is of paramount importance. Medical treatment is an important option for cases in which surgery was unsuccessful or not indicated. Despite the achievements in medical treatment, somatotropic tumor aggressiveness and/or resistance to the drugs currently available remain a concern. Therefore, novel therapy targets based on molecular pathogenesis of GH-secreting tumors are currently in development, aiming at fulfilling this important gap.
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Affiliation(s)
- Raquel S Jallad
- University of Sao Paulo Medical School, Hospital das Clinicas, Division of Endocrinology and Metabolism, Neuroendocrine Unit, São Paulo, Brasil
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Adelman DT, Liebert KJ, Nachtigall LB, Lamerson M, Bakker B. Acromegaly: the disease, its impact on patients, and managing the burden of long-term treatment. Int J Gen Med 2013; 6:31-8. [PMID: 23359786 PMCID: PMC3555549 DOI: 10.2147/ijgm.s38594] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Acromegaly is a rare disease most often caused by the prolonged secretion of excess growth hormone from a pituitary adenoma. The disease is associated with multiple significant comorbidities and increased mortality. The delay to diagnosis is often long. This may be because of low disease awareness among health care professionals, the insidious onset of differentiating features, and because patients are likely to present with complaints typical of other conditions more frequently seen in primary care. Early identification of acromegaly facilitates prompt treatment initiation and may minimize the permanent effects of excess growth hormone. The primary treatment for many patients will be pituitary surgery, although not all patients will be eligible for surgery or achieve a surgical cure. If biochemical control is not achieved following surgery, other treatment options include medical therapy and radiation therapy. Improved biochemical control may only alleviate rather than reverse the associated comorbidities. Thus, lifelong monitoring of patient health is needed, with particular attention to the management of cardiovascular risk factors. It is additionally important to consider the impact of both disease and treatment on patients’ quality of life and minimize that impact where possible, but particularly for chronic therapies. For the majority of patients, chronic therapy is likely to include somatostatin analog injections. In some circumstances, it may be possible to extend the dosing interval of the analog once good biochemical control is achieved. Additional convenience may be gained from the possibility of self-/partner administration of treatment or administration of treatment by a health care professional at home. Overall, it is clear that the care of patients with acromegaly requires a highly coordinated approach involving numerous specialties (eg, endocrinology, surgery, cardiology). Further, patients’ needs must be at the core of management and every effort must be made to improve health care experiences and minimize treatment burdens.
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Affiliation(s)
- Daphne T Adelman
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Adelman DT, Burgess A, Davies PR. Evaluation of long-acting somatostatin analog injection devices by nurses: a quantitative study. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2012; 5:103-9. [PMID: 23293542 PMCID: PMC3534535 DOI: 10.2147/mder.s37831] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The somatostatin analogs (SSAs) lanreotide Autogel/Depot and octreotide long-acting release are used to treat acromegaly and neuroendocrine tumors. The present study evaluated opinions on SSA injection devices, including a recently approved lanreotide new device (lanreotide-ND), among nurses in Europe and the USA. Nurses injecting SSAs for at least three patients per year (n = 77) were interviewed regarding SSA devices. Device attributes were rated via questionnaire; nurses were then timed administering test injections with lanreotide-ND and octreotide long-acting release. The most important delivery system attributes were easy/convenient preparation and injection (ranked in the top five by 70% of nurses), low clogging risk (58%), and high product efficacy (55%). Compared with the octreotide long-acting release device, lanreotide-ND scored higher on 15/16 attributes, had shorter mean preparation and administration time (329 versus 66 seconds, respectively; P ≤ 0.01) and a higher overall preference score (70 versus 114, respectively; P ≤ 0.01). The five most important lanreotide-ND attributes were: prefilled device, confidence a full dose was delivered, low clogging risk, easy/convenient preparation and injection, and fast administration. These device features could lead to improvements in clinical practice and benefit patients/caregivers who administer SSAs at home.
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Affiliation(s)
- Daphne T Adelman
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Abstract
This article presents management options for the patient with acromegaly after noncurative surgery. The current evidence for repeat surgery, adjuvant medical therapy with somatostatin analogues, dopamine agonists, the growth hormone receptor antagonist pegvisomant, combination medical therapy, and radiotherapy in the context of persistent postoperative disease are summarized. The relative advantages and disadvantages of each of these treatment modalities are explored, and a general treatment algorithm that integrates these modalities is proposed.
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Affiliation(s)
- Nestoras Mathioudakis
- Johns Hopkins University School of Medicine, Division of Endocrinology & Metabolism, Department of Medicine, Baltimore, MD 21287, USA
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Roemmler J, Schopohl J. Clinical experience with lanreotide for the treatment of acromegaly. Expert Rev Endocrinol Metab 2012; 7:139-149. [PMID: 30764005 DOI: 10.1586/eem.11.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Acromegaly is a rare disease, characterized in adults by its distinctive appearance of facial dysmorphism and swollen fingers. It is caused by an overproduction of growth hormone (GH) in more than 99% of patients and in nearly all cases is due to a pituitary adenoma. If surgical resection of the adenoma is not effective, medical treatment is usually the next treatment option. The most commonly used medications are the somatostatin analogues octreotide and lanreotide. Lanreotide is a synthetic somatostatin analogue and is available as slow-release microparticle (every 7-14 days) and prolonged-release liquid (autogel, every 28-56 days) formulations. Lanreotide autogel is a supersaturated aqueous formulation for deep subcutaneous injection and is sold in a ready-to-use prefilled syringe. This ease of use allows self or partner administration at home. This article reviews the use of lanreotide in the treatment of acromegaly and its advantages and disadvantages compared with other somatostatin analogues.
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Affiliation(s)
- Josefine Roemmler
- b Medizinische Klinik und Poliklinik IV, University of Munich, Ziemssenstr. 1, 80336 München, Germany.
| | - Jochen Schopohl
- a Medizinische Klinik und Poliklinik IV, University of Munich, Ziemssenstr. 1, 80336 München, Germany
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Carmichael JD. Lanreotide depot deep subcutaneous injection: a new method of delivery and its associated benefits. Patient Prefer Adherence 2012; 6:73-82. [PMID: 22298946 PMCID: PMC3269320 DOI: 10.2147/ppa.s20783] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Acromegaly is a rare disease characterized by excessive growth hormone secretion, usually from a pituitary tumor. Treatment options include surgery, medical therapy, and in some cases, radiation therapy. Current medical therapy consists of treatment with somatostatin analog medications or a growth hormone receptor antagonist. There are two somatostatin analogs currently in use, octreotide and lanreotide. Both are supplied in long-acting formulations and are of comparable biochemical efficacy. Lanreotide is supplied in a prefilled syringe and is injected into deep subcutaneous tissue. Studies have been conducted to assess the efficacy of self- or partner administration, and have demonstrated that injection of lanreotide can be accomplished reliably and safely outside a physician's office. For patients who have achieved biochemical control with lanreotide, the FDA has recently approved an extended dosing interval. Selected patients may be able to receive the medication less frequently with injections of 120 mg administered every 6 or 8 weeks. This review focuses on the use of lanreotide in the treatment of acromegaly, the safety and efficacy of the drug, and the benefits afforded to patients because of unique aspects of the delivery of lanreotide.
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Affiliation(s)
- John D Carmichael
- Correspondence: John D Carmichael, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA, Tel +1 310 423 2830, Fax +1 310 423 2819, Email
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Johanson V, Wilson B, Abrahamsson A, Jianu C, Calissendorff J, Wall N, Grønbæk H, Florholmen J, Öhberg A, Granberg D. Randomized crossover study in patients with neuroendocrine tumors to assess patient preference for lanreotide Autogel(®) given by either self/partner or a health care professional. Patient Prefer Adherence 2012; 6:703-10. [PMID: 23118529 PMCID: PMC3484527 DOI: 10.2147/ppa.s34337] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lanreotide Autogel(®) is supplied in prefilled syringes. Therefore, it is possible for patients with neuroendocrine tumors to use self-/partner-administered injections. The primary objective of this study was to assess the proportion of patients preferring self/partner injections over injections administered by health care professionals, and to describe the impact of self/partner administration on efficacy, safety, and costs. METHODS Of 62 eligible patients, 26 (42%) patients with neuroendocrine tumors treated with a stable dose of lanreotide Autogel 90 mg or 120 mg every 4 weeks agreed to participate in this Phase IV, international, open-label, crossover study, conducted at hospitals in Sweden, Norway, and Denmark. Patients were randomized to two blocks, starting with administration of lanreotide Autogel by either self/partner or a health care professional. Preference for injections administered by self/partner or health care professionals was measured, as well as efficacy, safety, and health care resource utilization (both direct and indirect costs). RESULTS Of 25 evaluable patients, 22 (88%) preferred self/partner injections, mainly because they experienced increased independence. Based on all patients asked to participate (n = 62), 35% preferred self/partner injections on a regular basis. There was no difference in efficacy or safety between the two administration blocks. CONCLUSION Many patients with neuroendocrine tumors prefer self/partner injection of lanreotide Autogel, and are able to self/partner inject without any impact on efficacy or safety. This administration method seems to provide a good alternative for suitable patients to increase patient independence and reduce the number of clinic visits.
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Affiliation(s)
- Viktor Johanson
- Department of Surgery, Sahlgrenska University Hospital, Göteborg, Sweden
- Correspondence: Viktor Johanson, Department of Surgery, Sahlgrenska University Hospital, Göteborg, Sweden, Tel +46 31 342 70 82, Fax +46 31 342 46 00, Email
| | - Benedicte Wilson
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Anna Abrahamsson
- Karolinska Institutet, Department of Hepatology, Karolinska University Hospital, Huddinge, Sweden
| | - Constantin Jianu
- Department of Gastroenterology and Liver Disease, St Olav Hospital, Trondheim, Norway
| | - Jan Calissendorff
- Karolinska Institutet, Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Solna, Sweden
| | - Najme Wall
- Department of Oncology, Linköping University Hospital, Linköping, Sweden
| | - Henning Grønbæk
- Department of Medicine V, Aarhus University Hospital, Aarhus, Denmark
| | - Jon Florholmen
- Department of Gastroenterology and Nutrition, University Hospital of North Norway, Tromsø, Norway
| | | | - Dan Granberg
- Department of Medical Sciences, Section of Endocrine Oncology, Uppsala University, Uppsala, Sweden
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Katznelson L, Atkinson JLD, Cook DM, Ezzat SZ, Hamrahian AH, Miller KK. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of acromegaly--2011 update. Endocr Pract 2011; 17 Suppl 4:1-44. [PMID: 21846616 DOI: 10.4158/ep.17.s4.1] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Laurence Katznelson
- Departments of Medicine and Neurosurgery, Stanford University, Stanford, California, USA
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