Long-term treatment of 189 acromegalic patients with the somatostatin analog octreotide. Results of the International Multicenter Acromegaly Study Group.
Long-term treatment of 189 acromegalic patients with the somatostatin analog octreotide. Results of the International Multicenter Acromegaly Study Group.
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DOI：
10.1001/archinte.151.8.1573
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发表时间：
1991-08
影响因子：
--
通讯作者：
M. L. Vance;Alan G. Harris
中科院分区：
文献类型：
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作者：
M. L. Vance;Alan G. Harris
背景我们想要确定189名肢端肥大症患者使用生长抑素类似物奥曲肽长期治疗的临床和生化效果。方法患者在23个医学中心接受治疗6天至231周(中位数24.2周)，用不同剂量的奥曲肽(100~1500微克/天；中位数300微克/天)。比较研究前后血清生长激素和胰岛素样生长因子I(IGF-I)的浓度，并寻找治疗反应与每日总剂量和治疗持续时间之间的相关性。结果无论剂量、疗程，临床有效率均为88%。182名患者中172名(94%)血清生长激素水平下降，99名患者中91名(92%)IGF-I水平下降。治疗前平均生长激素水平为39.4+/-4.4微克/L，降至12.2+/-1.5微克/L，82例(45%)生长激素水平降至<5微克/L。治疗前IGF-I水平为5.62+/-0.41U/m L，降至2.64+/-0.19U/m L，其中46例(46%)降至2U/m L或以下。生长激素抑制的程度与较长的治疗时间有关，但与每天奥曲肽的总剂量无关。在前瞻性研究的34名患者中，15名(44%)的垂体肿瘤缩小了20%以上。37%的患者出现副作用，最常见的是一过性疏松的酒精大便、注射部位疼痛和腹部不适；严重程度为轻度至中度。在接受评估的25名患者中，52%的患者糖耐量没有变化或改善，48%的患者糖耐量下降。结论奥曲肽是治疗肢端肥大症的一种有效方法，可作为治疗肢端肥大症的首选治疗方法，也可作为手术和/或垂体放疗后的治疗方法。
BACKGROUND We wanted to determine the clinical and biochemical effects of long-term therapy with the somatostatin analog octreotide in 189 acromegalic patients. METHODS Patients were treated at 23 medical centers for 6 days to 231 weeks (median, 24.2 weeks) with varying octreotide dosages (100 to 1500 micrograms/d; median, 300 micrograms/d). Serum growth hormone and insulin-like growth factor I (IGF-I) concentrations before and at the end of the study were compared, and correlations between the response to treatment with total daily dosage and duration of treatment were sought. RESULTS The clinical response rate was 88%, irrespective of dosage or treatment duration. Serum growth hormone levels decreased in 172 (94%) of 182 patients and IGF-I levels decreased in 91 (92%) of 99. The mean pretreatment growth hormone level was 39.4 +/- 4.4 micrograms/L and decreased to 12.2 +/- 1.5 micrograms/L. Growth hormone levels decreased to less than 5 micrograms/L in 82 (45%) of 182 patients. The pretreatment IGF-I level was 5.62 +/- 0.41 U/mL and decreased to 2.64 +/- 0.19 U/mL; suppression to 2 U/mL or lower occurred in 46 (46%) of 99 patients. The degree of growth hormone suppression was associated with longer treatment duration but not with the total octreotide dosage per day. In 34 patients studied prospectively, pituitary tumor size decreased by greater than 20% in 15 (44%). Side effects occurred in 37% of patients and were most commonly transient loose alcoholic stools, pain at the injection site, and abdominal discomfort; severity was mild to moderate. Glucose tolerance was unchanged or improved in 52% and declined in 48% of 25 patients evaluated. CONCLUSIONS Octreotide is an effective treatment for acromegaly that may be used as primary therapy or after surgery and/or pituitary irradiation.