Efficacy of the long-acting repeatable formulation of the somatostatin analogue octreotide in postoperative dumping.
OBJECTIVE
Several studies have established symptomatic and mechanistic benefits of the somatostatin analogue octreotide in patients with dumping syndrome, but clinical use is hampered by the requirement for subcutaneous administration 3 times daily. We compared the efficacy of subcutaneous octreotide with that of the long-acting repeatable (LAR) octreotide formulation, which is administered monthly, in patients with dumping syndrome.


METHODS
The study included 30 consecutive patients with postoperative dumping, evidenced by oral glucose tolerance test (OGTT) results and insufficient response to dietary measures. OGTT, dumping severity score (summary of scores 0-3 for 8 early and 6 late dumping symptoms), and quality-of-life data were evaluated at baseline, after 3 days of subcutaneous administration of octreotide (0.5 mg), and then after 3 monthly intramuscular injections of octreotide LAR (20 mg).


RESULTS
Both formulations of octreotide significantly reduced total dumping severity scores (21.7 +/- 1.6 at baseline, 11.2 +/- 1.2 for subcutaneous and 14.0 +/- 1.8 for LAR formulations; P < .05). This reduction was associated with significant improvements in the increase in pulse rate (13.8 +/- 5.8 at baseline vs -0.3 +/- 2.2 and 1.9 +/- 1.7; P < .05) as well as the increase in hematocrit level (4.0 +/- 1.4 at baseline vs 0.3 +/- 0.9. and 0.4 +/- 1.0; P < .05), and the lowest glycemia level in the OGTT (54.1 +/- 6.7 at baseline vs 98.9 +/- 7.1 and 67.8 +/- 5.9; P < .05). LAR octreotide administration significantly improved patients' quality of life. Patients' evaluations of their overall treatment efficacy was higher on LAR compared with the subcutaneous formulation (83% vs 52%; P = .01). Gallbladder stones occurred in 4 patients.


CONCLUSIONS
Monthly administration of LAR octreotide improves OGTT results, symptoms, and quality of life in patients with postoperative dumping.
Arts
Joris
J
Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium.
Caenepeel
Philip
P
Bisschops
Raf
R
Dewulf
Dominiek
D
Holvoet
Lieselot
L
Piessevaux
Hubert
H
Bourgeois
Stefan
S
Sifrim
Daniel
D
Janssens
Jozef
J
Tack
Jan
J
D000328:Adult; D001530:Belgium; D003692:Delayed-Action Preparations / Q000627:therapeutic use*; D004377:Dumping Syndrome / Q000188:drug therapy*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D005951:Glucose Tolerance Test; D006801:Humans; D008297:Male; D015282:Octreotide / Q000627:therapeutic use*; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome
D003692:Delayed-Action Preparations; D005765:Gastrointestinal Agents; D015282:Octreotide