Эффективность и безопасность лечения Сандостатином® ЛАР в высоких дозах: обзор исследований Европейских центров


Иловайская И.А.

МОНИКИ им. М.Ф. Владимирского, Москва
Медикаментозная терапия аналогами соматостатина занимает важное место в лечении акромегалии и применяется как дополнительное лечение после нейрохирургического вмешательства или как первичная терапия. Пролонгированная форма октреотида швейцарского производства (Сандостатин® ЛАР) является наиболее изученным и широко применяемым аналогом соматостатина. Начальная доза Сандостатина® ЛАР обычно составляет 20 мг, однако, по данным многих исследований, было отмечено, что после первых 3 месяцев лечения не всегда достигается ремиссия акромегалии и для улучшения контроля над заболеванием необходимо увеличивать дозу препарата у большей части пациентов. Данный обзор посвящен применению Сандостатина® ЛАР в высоких (30 мг в месяц и более) дозах в лечении пациентов с активной акромегалией. Применение Сандостатина® ЛАР в высоких (30 мг в месяц и более) дозах повышает эффективность достижения биохимического контроля над активной акромегалией, не ухудшая при этом профиль безопасности данного препарата.

Литература


1. Holdaway IM, Bolland MJ, Gamble GD. A metaanalysis of the effect of lowering serum levels of GH and IGF-I on mortality in acromegaly. Eur J Endocrinol 2008;159:89–95.


2. Ludecke DK, Abe T. Transsphenoidal microsurgery for newly diagnosed acromegaly: a personal view after more than 1,000 operations. Neuroendocrinology 2006;83:230–39.


3. Nomikos P, Buchfelder M, Fahlbusch R. The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical “cure”. Eur J Endocrinol 2005;152:379–87.


4. Melmed S, Casanueva F, Cavagnini F, et al. Consensus statement: medical management of acromegaly. Eur J Endocrinol 2005;153:737–40.


5. Freda PU, Katznelson L, van der Lely AJ, et al. Long-acting somatostatin analog therapy of acromegaly: a meta-analysis. J Clin Endocrinol Metab 2005;90:4465–73.


6. Ayuk J, Sheppard MC. Does acromegaly enhance mortality? Rev Endocr Metab Disord 2007; 9:33–39.


7. Ayuk J, Sheppard MC. Growth hormone and its disorders. Postgrad Med J 2006;82:24–30.


8. Colao A, Ferone D, Marzullo P, et al. Long-term effects of depot long-acting somatostatin analog octreotide on hormone levels and tumor mass in acromegaly. J Clin Endocrinol Metab 2001;86:2779–86.


9. Colao A, Pivonello R, Auriemma RS, et al. Beneficial effect of dose escalation of octreotide LAR as first-line therapy in patients with acromegaly. Eur J Endocrinol 2007;157:579–87.


10. Lancranjan I, Bruns C, Grass P, et al. Sandostatin® LAR®: a promising therapeutic tool in the management of acromegalic patients. Metabolism 1996;45:67–71.


11. Lancranjan I, Atkinson AB. Results of a European multicentre study with Sandostatin LAR in acromegalic patients. Sandostatin LAR Group. Pituitary 1999;1:105–14.


12. Cozzi R, Attanasio R, Montini M, et al. Four-year treatment with octreotide-long-acting repeatable in 110 acromegalic patients: predictive value of short-term results? J Clin Endocrinol Metab 2003;88:3090–98.


13. Cozzi R, Montini M, Attanasio R, et al. Primary treatment of acromegaly with octreotide LAR: a longterm (up to 9 years) prospective study of its efficacy in the control of disease activity and tumor shrinkage. J Clin Endocrinol Metab 2006;91:1397–403.


14. Colao A, Pivonello R, Rosato F, et al. First-line octreotideLAR therapy induces tumor shrinkage and controls hormone excess in patients with acromegaly: results from an open, prospective, multicentre trial. Clin Endocrinol (Oxf) 2006;64:342–51.


15. Mercado M, Borges F, Bouterfa H, et al. A prospective, multicentre study to investigate the efficacy, safety and tolerability of octreotide LAR (long-acting repeatable octreotide) in the primary therapy of patients with acromegaly. Clin Endocrinol (Oxf) 2007;66:859–68.


16. Yetkin DO, Boysan SN, Tiryakioglu O, et al. Fortymonth follow up of persistent and difficultly controlled acromegalic patients treated with depot long acting somatostatin analog octreotide. Endocr J 2007;54:459–64.


17. Colao A, Cappabianca P, Caron P, et al. Octreotide LAR vs. surgery in newly diagnosed patients with acromegaly: a randomized, open-label, multicentre study. Clin Endocrinol (Oxf) 2009;70:757–68.


18. Gilbert J, Ketchen M, Kane P, et al. The treatment of de novo acromegalic patients with octreotide-LAR: efficacy, tolerability and cardiovascular effects. Pituitary 2003;6:11–18.


19. Colao A, Pivonello R, Galderisi M, et al. Impact of treating acromegaly first with surgery or somatostatin analogs on cardiomyopathy. J Clin Endocrinol Metab 2008;93:2639–46.


20. Colao A, Marzullo P, Cuocolo A, et al. Reversal of acromegalic cardiomyopathy in young but not in middle-aged patients after 12 months of treatment with the depot long-acting somatostatin analogue octreotide. Clin Endocrinol (Oxf) 2003; 58:169–76.


21. Cook D. Octreotide long-acting repeatable in acromegaly: achieving optimal control. Endocrinologist 2009;19:142–147.


22. Giustina A, Bonadonna S, Bugari G, et al. High-dose intramuscular octreotide in patients with acromegaly inadequately controlled on conventional somatostatin analogue therapy: a randomised controlled trial. Eur J Endocrinol 2009;161:331–38.


23. Feelders RA, Hofland LJ, van Aken MO, et al. Medical therapy of acromegaly: efficacy and safety of somatostatin analogues. Drugs 2009;69:2207–26.


24. McKeage K, Cheer S, Wagstaff AJ. Octreotide long-acting release (LAR): a review of its use in the management of acromegaly. Drugs 2003; 63:2473–99.


25. Colao A, Auriemma RS, Galdiero M, et al. Impact of somatostatin analogs vs. surgery on glucose metabolism in acromegaly: Results of a 5 years observational, open, prospective study. J Clin Endocrinol Metab 2009;94:528–37.


26. Melmed S, Colao A, Barkan A, et al. Guidelines for acromegaly management: an update. J Clin Endocrinol Metab 2009;94:1509–17.


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