Endocrinology Service and Experimental Endocrinology Unit, Hospital de Especialidades, CMN S.XXI, IMSS, Aristoteles 68, Polanco 11560, Mexico City, Mexico.
Eur J Endocrinol. 2012 Jan;166(1):21-6. doi: 10.1530/EJE-11-0738. Epub 2011 Oct 12.
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.
To evaluate the feasibility of discontinuing therapy in well-controlled patients with acromegaly treated chronically with SA.
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.
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.
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.
生长抑素类似物（SA）在治疗肢端肥大症方面已经使用了超过 25 年。主要的缺点是需要无限期地继续治疗。
评估在接受 SA 慢性治疗且病情得到良好控制的肢端肥大症患者中，停止治疗的可行性。
在接受奥曲肽 LAR 治疗的 205 名患者中，我们选择了符合以下标准的患者：治疗时间超过两年，在过去一年中，剂量稳定，注射间隔为每 8 周 20 毫克或更长时间，没有放射治疗史，没有使用卡培溴铵在过去 6 个月，GH<1.5ng/ml，IGF1<1.2×正常上限（ULN）。停止奥曲肽 LAR 治疗，每月测量 GH 和 IGF1 一次，共 4 个月；在第 4 个月进行葡萄糖抑制 GH 值和磁共振成像检查，此后每 3 个月测量基础 GH 和 IGF1，持续 12-18 个月。如果 GH 或 IGF1 升高至 1.5ng/ml 或 1.2×ULN，则患者将被从研究中剔除。
12 名患者（10 名女性，平均年龄 48±13 岁）接受了研究。在停止 SA 治疗后的 1 年内，7 名患者（58.3%）生化复发；2 名患者根据 GH 和 IGF1 标准复发，其余 5 名患者保持 GH 水平在目标范围内。在 12 个月的随访后，有 5 名患者（41.7%）仍处于缓解状态。未复发患者的注射间隔时间较长，但没有其他特征与成功停药相关。
在一小部分病情得到很好控制的患者中，尤其是在接受低剂量、长间隔给药的患者中，停止 SA 治疗是可能的。
