Therapeutic options in the management of acromegaly: focus on lanreotide Autogel

Abstract

Background: In acromegaly, expert surgery is curative in only about 60% of patients. Postoperative radiation therapy is associated with a high incidence of hypopituitarism and its effect on growth hormone (GH) production is slow, so that adjuvant medical treatment becomes of importance in the management of many patients.

Objective: To delineate the role of lanreotide in the treatment of acromegaly.

Methods: Search of Medline, Embase, and Web of Science databases for clinical studies of lanreotide in acromegaly.

Results: Treatment with lanreotide slow release and lanreotide Autogel((R)) normalized GH and insulin-like growth factor-I (IGF-I) concentrations in about 50% of patients. The efficacy of 120 mg lanreotide Autogel((R)) on GH and IGF-I levels was comparable with that of 20 mg octreotide LAR. There were no differences in improvement of cardiac function, decrease in pancreatic beta-cell function, or occurrence of side effects, including cholelithiasis, between octreotide LAR and lanreotide Autogel(R). When postoperative treatment with somatostatin analogs does not result in normalization of serum IGF-I and GH levels after noncurative surgery, pegvisomant alone or in combination with somatostatin analogs can control these levels in a substantial number of patients.

Keywords: acromegaly; growth hormone; lanreotide; pegvisomant; somatostatin analog.

Figure 1

Amino acid structure of somatostatin-14, octreotide. and lanreotide.

Figure 2

Pharmacokinetic profiles of lanreotide Autogel^® (90 mg) and octreotide-LAR (20 mg) at steady state. The lines represent mean values of 10 simulated profiles. From data of Astruc et al (2005).