Yuen KCJ, Samson SL. Oral Octreotide: A Review of Recent Clinical Trials and Practical Recommendations for Its Use in the Treatment of Patients With Acromegaly.
Endocr Pract 2022;
28:637-645. [PMID:
35452815 DOI:
10.1016/j.eprac.2022.04.009]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/15/2022] [Accepted: 04/15/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE
Acromegaly is characterized by chronic growth hormone (GH) and insulin-like growth factor-I (IGF-I) hypersecretion, often caused by a GH-secreting pituitary adenoma. Surgery remains first line, but medical therapy is essential if surgery is contraindicated, does not achieve remission, or does not prevent recurrence despite apparent surgical remission. Oral octreotide capsules (OOC) that combine octreotide with a transient permeability enhancer technology are the first oral somatostatin receptor ligand (SRL) approved in the US for acromegaly.
METHODS
We review the literature and clinical trial data of OOC for patients with acromegaly and discuss clinical assessment of OOC use, potential drug-drug interactions, drug initiation, dose titration, and monitoring of drug efficacy and tolerability.
RESULTS
Four pivotal clinical trials involving a total of 238 patients with acromegaly treated with OOC effective suppression of serum GH and IGF-I levels, maintenance of disease control, decreased breakthrough symptoms and symptomatic improvement with noninferiority of OOC to injectable SRLs (iSRLs) in maintaining biochemical response. Additionally, the safety profile of OOC is comparable to that of iSRLs. Most patients who completed the clinical trials of OOC have also expressed preference to oral compared to iSRL administration.
CONCLUSION
OOC is an effective treatment option for patients with acromegaly who previously responded to iSRLs, with the benefits of avoiding injection-related side effects. This article provides a review of the pharmacology, safety, and efficacy and offers practical recommendations on utilization of OOCs to treat iSRL-responsive patients with acromegaly.
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