title: Discontinuation of octreotide LAR after long term, successful treatment of patients with acromegaly: is it worth trying?
abstract: BACKGROUND
  Somatostatin analogs (SA) have been used for over 25 years in the treatment of acromegaly. A major disadvantage is the need to continue therapy indefinitely.
  
  
  OBJECTIVE
  To evaluate the feasibility of discontinuing therapy in well-controlled patients with acromegaly treated chronically with SA.
  
  
  METHODS
  Of the 205 subjects on octreotide LAR, we selected those who met the following criteria: two or more years of treatment, a stable dose and injection interval of 20  mg every 8 weeks or longer for the previous year, no history of radiation, no cabergoline for the previous 6 months, a GH <1.5  ng/ml, and an IGF1 <1.2×upper limit of normal (ULN). Octreotide LAR was stopped and both GH and IGF1 were measured monthly for 4 months; a glucose-suppressed GH value and magnetic resonance imaging were obtained at the 4th month, thereafter, basal GH and IGF1 were measured q. 3 months, for 12-18 months. Patients were removed from the study if GH or IGF1 rose to 1.5  ng/ml or 1.2×ULN respectively.
  
  
  RESULTS
  Twelve patients (ten women, mean age 48±13 years) were studied. Seven patients (58.3%) relapsed biochemically within 1 year of having stopped the SA; two patients relapsed by GH and IGF1 criteria, the remaining five patients kept GH levels within target. Five patients (41.7%) remain in remission after 12 months of follow-up. Non-recurring patients were on longer injection intervals but no other characteristic was associated with a successful withdrawal.
  
  
  CONCLUSIONS
  Withdrawal of SA is possible in a small but distinct subset of patients, particularly in those who are very well controlled on relatively low doses administered at long intervals.
authors: Endocrinology Service and Experimental Endocrinology Unit, Hospital de Especialidades, CMN S.XXI, IMSS, Aristoteles 68, Polanco 11560, Mexico City, Mexico.
authors: Claudia
authors: C
authors: Ramírez
authors: Guadalupe
authors: G
authors: Vargas
authors: Baldomero
authors: B
authors: González
authors: Ashley
authors: A
authors: Grossman
authors: Julia
authors: J
authors: Rábago
authors: Ernesto
authors: E
authors: Sosa
authors: Ana Laura
authors: AL
authors: Espinosa-de-Los-Monteros
authors: Moisés
authors: M
authors: Mercado
mesh_terms: D000172:Acromegaly / Q000188:drug therapy* / Q000378:metabolism; D000328:Adult; D000368:Aged; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage* / Q000627:therapeutic use*
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D015282:Octreotide