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. CONCLUSION: 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.
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. CONCLUSION: 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: Shaun J Kilty; Myriam G M Hunink; Lisa Caulley; Eline Krijkamp; Mary-Anne Doyle; Kednapa Thavorn; Fahad Alkherayf; Nick Sahlollbey; Selina X Dong; Jason Quinn; Stephanie Johnson-Obaseki; David Schramm Journal: Pituitary Date: 2022-08-27 Impact factor: 3.599
Authors: Renato Cozzi; Maria R Ambrosio; Roberto Attanasio; Alessandro Bozzao; Laura De Marinis; Ernesto De Menis; Edoardo Guastamacchia; Andrea Lania; Giovanni Lasio; Francesco Logoluso; Pietro Maffei; Maurizio Poggi; Vincenzo Toscano; Michele Zini; Philippe Chanson; Laurence Katznelson Journal: Endocr Metab Immune Disord Drug Targets Date: 2020 Impact factor: 2.895
Authors: Michiel J van Esdonk; Eline J M van Zutphen; Ferdinand Roelfsema; Alberto M Pereira; Piet H van der Graaf; Nienke R Biermasz; Jasper Stevens; Jacobus Burggraaf Journal: Pituitary Date: 2018-06 Impact factor: 4.107
Authors: E Sala; G Carosi; G Del Sindaco; R Mungari; A Cremaschi; A L Serban; C L Ronchi; E Ferrante; M Arosio; G Mantovani Journal: J Endocrinol Invest Date: 2021-05-20 Impact factor: 4.256