Long-Term Remission of Acromegaly after Octreotide Withdrawal Is an Uncommon and Frequently Unsustainable Event

Long-Term Remission of Acromegaly after Octreotide Withdrawal Is an Uncommon and Frequently Unsustainable Event

Author Casagrande, Alessandra Autor UNIFESP Google Scholar
Bronstein, Marcello Delano Autor UNIFESP Google Scholar
Jallad, Raquel Soares Autor UNIFESP Google Scholar
Moraes, Aline B. Google Scholar
Elias, Paula C. L. Google Scholar
Castro, Margaret Google Scholar
Czepielewski, Mauro A. Google Scholar
Boschi, Artur Google Scholar
Ribeiro-Oliveira, Antonio, Jr. Google Scholar
Schweizer, Junia R. O. L. Google Scholar
Vilar, Lucio Google Scholar
Nazato, Debora Maria Autor UNIFESP Google Scholar
Gadelha, Monica R. Google Scholar
Abucham, Julio Autor UNIFESP Google Scholar
Abstract 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 x 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 (shortterm) 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 x ULN. No other predictive factor for short-or long-term remission was found. Conclusion: Our results show that long-term remission of acromegaly afteroctreotide LAR withdrawal was an uncommon and frequently unsustainable event and do not support the recommendation of a systematic withdrawal of treatment in controlled patients. (C) 2016 S. Karger AG, Basel
Keywords Acromegaly
Somatostatin analog
xmlui.dri2xhtml.METS-1.0.item-coverage Basel
Language English
Sponsor Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Grant number CAPES: 528/11
Date 2017
Published in Neuroendocrinology. Basel, v. 104, n. 3, p. 273-279, 2017.
ISSN 0028-3835 (Sherpa/Romeo, impact factor)
Publisher Karger
Extent 273-279
Origin http://dx.doi.org/10.1159/000446542
Access rights Closed access
Type Article
Web of Science ID WOS:000396797700006
URI https://repositorio.unifesp.br/handle/11600/56397

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