Alkaline phosphatase predicts response in polycystic liver disease during somatostatin analogue therapy: a pooled analysis

Abstract

Background & aims: Somatostatin analogues reduce liver volumes in polycystic liver disease. However, patients show considerable variability in treatment responses. Our aim was to identify specific patient, disease or treatment characteristics that predict response in polycystic liver disease during somatostatin analogue therapy.

Methods: We pooled the individual patient data of four trials that evaluated long-acting somatostatin analogues (120 mg lanreotide or 40 mg octreotide) for 6-12 months in polycystic liver disease patients. We performed uni- and multivariate linear regression analysis with preselected patient, disease and drug variables to identify independent predictors of response, defined as per cent change in liver or kidney volume (in ADPKD subgroup). All analyses were adjusted for baseline liver volume and centre.

Results: We included 153 polycystic liver disease patients (86% female, median liver volume 4974 ml) from three international centres, all treated with octreotide (n = 70) or lanreotide (n = 83). Mean reduction in liver volume was 4.4% (range -31.6 to +9.4%). Multivariate linear regression revealed that elevated baseline alkaline phosphatase was associated with increased liver volume reduction during therapy (-2.7%, 95% CI -5.1 to -0.2%, P = 0.04), independently of baseline liver volume. Somatostatin analogue type, underlying diagnosis and eGFR did not affect response. In our ADPKD subpopulation (n = 100), elevated alkaline phosphatase predicted liver volume reduction (-3.2%, P = 0.03) but did not predict kidney volume reduction (+0.1%, P = 0.97). Total gastro-intestinal symptom severity decreased with therapy in a subgroup analysis (n = 95; P < 0.001).

Conclusion: Alkaline phosphatase is a liver-specific, independent predictor of response in polycystic liver disease during somatostatin analogue therapy.

Keywords: ADPKD; ADPLD; alkaline phosphatase; drug therapy; hepatic cyst; somatostatin.

Fig. 1

Liver volume reduction according to ALP status. Per cent changes in liver volume in 153 PLD patients with normal (n = 105) and elevated ALP (n = 48) at baseline. Data are shown in mean and 95% CI.

Fig. 2

Liver and kidney volume reduction in ADPKD subpopulation according to ALP status. Per cent reduction in kidney (A) and liver volumes (B) in 100 ADPKD patients with normal (n = 76) and elevated ALP (n = 24) at baseline. Data are shown in mean and 95% CI.