title: Long-Term Remission of Acromegaly after Octreotide Withdrawal Is an Uncommon and Frequently Unsustainable Event.
abstract: BACKGROUND
  Long-term remission of acromegaly after somatostatin analog withdrawal has been reported in 18-42% of patients in studies with a relatively small number of patients using different inclusion and remission criteria. The objectives of this study were to establish the probability and predictive factors for short- and long-term remission [normal IGF-1 for age/sex: IGF-1 ≤1.00 × upper limit of normal (ULN)] after octreotide long-acting release (LAR) withdrawal in a larger population of well-controlled patients with acromegaly (normal mean IGF-1 in the last 24 months).
  
  
  METHODS
  This is a prospective multicenter study in which 58 well-controlled patients with acromegaly receiving only octreotide LAR as a primary or postsurgical treatment were included in 14 university centers in Brazil. All patients had been on stable doses and dose intervals of octreotide LAR in the last year, and none had been submitted to radiotherapy. The main outcome measure was serum IGF-1 after 8 weeks (short-term) and 60 weeks (long-term) of octreotide LAR withdrawal.
  
  
  RESULTS
  Seventeen of 58 patients (29%) were in remission in the short term, and only 4 patients achieved long-term remission after treatment withdrawal. The Kaplan-Meier estimated remission probability at 60 weeks was 7% and decreased to 5% at 72 weeks. The short-term remission rate was significantly higher (44%; p = 0.017) in patients with pretreatment IGF-1 <2.4 × ULN. No other predictive factor for short- or long-term remission was found.
  
  
  CONCLUSIONS
  Our results show that long-term remission of acromegaly after octreotide LAR withdrawal was an uncommon and frequently unsustainable event and do not support the recommendation of a systematic withdrawal of treatment in controlled patients.
authors.affiliation: Neuroendocrine Unit, Division of Endocrinology and Metabolism, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Casagrande
authors.forename: Marcello D
authors.initials: MD
authors.lastname: Bronstein
authors.forename: Raquel S
authors.initials: RS
authors.lastname: Jallad
authors.forename: Aline B
authors.initials: AB
authors.lastname: Moraes
authors.forename: Paula C L
authors.initials: PC
authors.lastname: Elias
authors.forename: Margaret
authors.initials: M
authors.lastname: Castro
authors.forename: Mauro A
authors.initials: MA
authors.lastname: Czepielewski
authors.forename: Artur
authors.initials: A
authors.lastname: Boschi
authors.forename: Antonio
authors.initials: A
authors.lastname: Ribeiro-Oliveira
authors.forename: Junia R O L
authors.initials: JR
authors.lastname: Schweizer
authors.forename: Lucio
authors.initials: L
authors.lastname: Vilar
authors.forename: Debora M
authors.initials: DM
authors.lastname: Nazato
authors.forename: Mônica R
authors.initials: MR
authors.lastname: Gadelha
authors.forename: Julio
authors.initials: J
authors.lastname: Abucham
mesh_terms: D000172:Acromegaly / Q000097:blood / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D005260:Female; D013006:Growth Hormone / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D011446:Prospective Studies; D012074:Remission Induction; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000209:etiology; D013997:Time Factors; D055815:Young Adult
chemical_list: D018931:Antineoplastic Agents, Hormonal; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone; D015282:Octreotide