Octreotide treatment of carcinoid syndrome: analysis of published dose-titration data.
BACKGROUND
Octreotide has proven therapeutically effective in carcinoid syndrome, but the rarity of carcinoid tumors has hampered detailed dose-ranging studies. This study analysed published dose-titration data on octreotide use in carcinoid patients to (a) investigate the relation between octreotide dose and efficacy and (b) establish octreotide dosing recommendations for maximum therapeutic benefit.


METHODS
An exhaustive, computer-assisted literature search for published articles employing octreotide to manage patients with carcinoid syndrome was performed using several databases. The relation between octreotide dose and efficacy in decreasing urinary 5-hydroxyindoleacetic acid (5-HIAA) levels, flushing and diarrhoea was analysed for seven dose ranges by pooling data from selected articles.


RESULTS
Analysis of data compiled from 62 published studies revealed that maximum effective therapeutic doses of octreotide effectively controlled symptoms in up to 93% of patients, and that increasing the dose of octreotide is associated with increased benefit with respect to control of flushing, diarrhoea and 5-HIAA levels.


CONCLUSIONS
We recommend starting octreotide therapy at 100 micrograms subcutaneously t.d.s. in patients with mild/moderate, non-life-threatening carcinoid syndrome. Since therapeutic response to octreotide varies markedly among patients, we recommend titrating the octreotide dose in increments of 50-100 micrograms every 8 h until adequate symptom control is achieved.
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048-1865, USA.
A G
AG
Harris
J S
JS
Redfern
D002276:Carcinoid Tumor / Q000188:drug therapy*; D003967:Diarrhea / Q000139:chemically induced; D004305:Dose-Response Relationship, Drug; D005483:Flushing / Q000139:chemically induced; D005500:Follow-Up Studies; D006801:Humans; D015282:Octreotide / Q000627:therapeutic use*; D013223:Statistics as Topic
D015282:Octreotide