Suliman M, Jenkins R, Ross R, Powell T, Battersby R, Cullen D R
Department of Endocrinology, Royal Hallamshire Hospital, Sheffield, United Kingdom.
J Endocrinol Invest. 1999 Jun;22(6):409-18. doi: 10.1007/BF03343583.
To assess the efficacy and tolerability of SR-lanreotide in the treatment of active acromegaly.
30 patients (17 men and 13 women) were treated in whom active acromegaly was confirmed by clinical features, a mean GH level of >5 mlU/l and failure to suppress GH to <2 mlU/l after a 75 g glucose load. Patients were treated for a median period of 60 weeks (range 12-168) with im injections of SR-lanreotide 30 mg given every 7-14 days.
Mean GH and IGF-I levels were measured at baseline and every 12-weeks together with symptom score assessment. MRI of the pituitary gland was performed at baseline and if an adenoma was identified at yearly intervals. Gall bladder ultrasound scans were performed at baseline and then every 24-weeks.
Twenty-three patients were treated for at least 48-weeks and, in these, GH levels fell from 10.5 mlU/l (7.6-17.6) (median and interquartile range) at baseline to 3.2 mlU/l (2.4-3.9) (p<0.0001) and IGF-I levels ftom 88.9 nmol/L (71.4-137.1) to 56.8 nmol/l (39.3-75.4) (p=0.0002). GH response to treatment was better in elderly patients (age> or =65 years) compared to younger patients but neither sex, pre-treatment GH levels, previous surgery nor previous radiotherapy influenced the response. Treatment resulted in a significant improvement in the symptoms of active acromegaly in the majority of patients. A significant reduction in the size of the pituitary adenoma was documented in 6 of 10 patients who had a repeat MRI scan after one year. Treatment was well-tolerated by the majority of patients; side effects were mainly transient gastrointestinal symptoms. These were severe in only 2 patients necessitating discontinuation of the drug. Two patients developed new gall stones and 4 female patients had temporal hair loss necessitating stopping treatment in one of them. There were minor effects on glucose tolerance which were not of clinical importance.
Long-term treatment of acromegaly with SR-lanreotide is effective in controlling GH and IGF-I levels and symptoms and is well tolerated in the majority of patients.
评估缓释兰瑞肽治疗活动性肢端肥大症的疗效和耐受性。
30例患者（17例男性和13例女性）接受治疗，其活动性肢端肥大症通过临床特征、平均生长激素（GH）水平>5 mIU/L以及口服75 g葡萄糖负荷后未能将GH抑制至<2 mIU/L得以确诊。患者接受每7 - 14天一次30 mg缓释兰瑞肽肌肉注射，中位治疗时间为60周（范围12 - 168周）。
在基线时以及每12周测量平均GH和胰岛素样生长因子-I（IGF-I）水平，并进行症状评分评估。在基线时进行垂体磁共振成像（MRI）检查，若发现腺瘤则每年进行一次检查。在基线时以及随后每24周进行胆囊超声扫描。
23例患者接受治疗至少48周，在这些患者中，GH水平从基线时的10.5 mIU/L（7.6 - 17.6）（中位数和四分位间距）降至3.2 mIU/L（2.4 - 3.9）（p<0.0001），IGF-I水平从88.9 nmol/L（71.4 - 137.1）降至56.8 nmol/L（39.3 - 75.4）（p = 0.0002）。与年轻患者相比，老年患者（年龄≥65岁）对治疗的GH反应更好，但性别、治疗前GH水平、既往手术及既往放疗均不影响反应。治疗使大多数活动性肢端肥大症患者的症状得到显著改善。在10例接受一年后重复MRI扫描的患者中，有6例记录到垂体腺瘤大小显著缩小。大多数患者对治疗耐受性良好；副作用主要为短暂的胃肠道症状。仅2例患者症状严重，需停药。2例患者出现新发胆结石，4例女性患者出现颞部脱发，其中1例需停药。对葡萄糖耐量有轻微影响，但无临床意义。
缓释兰瑞肽长期治疗肢端肥大症可有效控制GH和IGF-I水平及症状，大多数患者耐受性良好。
