Abstract
Purpose
Chronic idiopathic diarrhea is the passage of loose stools >3 times daily, or a stool
weight >200 g/d, persisting for >4 weeks without clear clinical cause. Patients refractory
to standard anti-diarrhetics have limited treatment options. Somatostatin analogues
have the ability to reduce gastrointestinal secretions and motility. This study evaluated
the efficacy and safety of lanreotide Autogel* 120 mg in chronic idiopathic diarrhea.
Methods
Other anti-diarrhetics were not allowed during the study and were stopped at screening.
Patients received lanreotide Autogel 120 mg at baseline and day 28. Stool frequency
and consistency (Bristol Stool Scale) were recorded; quality of life (QoL) was assessed
using the 36-item Short Form Health Survey and irritable bowel syndrome QoL questionnaires;
adverse events were monitored. The primary outcome was the proportion of patients
with a reduction of ≥50% or normalization to a mean of ≤3 stools/d at day 28.
Findings
Thirty-three patients with >3 stools/d at baseline were included; mean (SD) age was
55.2 (16.4) years. Fourteen patients (42.4%) had a response to lanreotide Autogel
at day 28 and 17 (51.5%) at day 56. Mean (SD) number of stools decreased significantly
from 5.7 (2.2) at baseline to 3.7 (2.2) at day 56 overall (n = 32; P < 0.001). Significant and clinically meaningful improvements in disease-specific
QoL were found in the overall populations. No new safety signals emerged.
Implications
Lanreotide Autogel 120 mg decreased symptoms in these patients with chronic idiopathic
refractory diarrhea, and meaningfully improved QoL. These finding have to be confirmed
in further clinical trials. ClinicalTrials.gov Identification: NCT00891371; Eudract
CT 2009-009356-20
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical TherapeuticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Guidelines for the Investigation of Chronic Diarrhoea, 2nd edition.Gut. 2003; 52: v1-15
- AGA technical review on the evaluation and management of chronic diarrhea.Gastroenterology. 1999; 116: 1464-1486
- Evaluation of chronic diarrhea.Am Fam Physician. 2011; 84: 1119-1126
- Lanreotide Autogel Autogel®: a review of its use in the treatment of patients with acromegaly.Drugs. 2014; 74: 1673-1691
- SMS 201-885 a somatostatin analogue and diarrhea in AIDS.Ann Intern Med. 1988; 109: 680-681
- Vapreotide, a somatostatin analogue, in cryptosporidiosis and other AIDS-related diarrhoea diseases.AIDS. 1992; 6: 715-718
- Effect of octreotide on refractory AIDS-associated diarrhea.Ann Int Med. 1991; 115: 705-710
- Efficacy of octreotide in the management of chronic diarrhea in AIDS.AIDS. 1992; 5: 1495-1499
- Pilot study of sandostatin therapy of refractory HIV-associated diarrhea.Dig Dis Sci. 1991; 36: 476-480
- Diarrhea in patients with the acquired immunodeficiency syndrome.Gastroenterology. 1993; 105: 1238-1242
- Light microscopic diagnosis of human microsporidiosis and variable response to octreotide.Gastroenterology. 1991; 100: 271-273
- Diarrhea in terminally ill patients: pathophysiology and treatment.J Pain Symptom Manage. 1995; 10: 298-309
- Phase I trial of somtostatin analog octreotide acetate in the treatment of fluoropyrimidineinduced diarrhea.J Clin Oncol. 1995; 13: 222-226
- Antidiarrheal agents for the management of treatment-related diarrhea in cancer patients.Am J Health Syst Pharm. 1998; 55: 1573-1580
- Use of octreotide in the symptomatic management of diarrhea induced by graft-versus-host disease in patients with hematologic malignancies.J Clin Oncol. 1997; 15: 3350-3354
- Efficacy of octreotide in controlling refractory diarrhea following bone marrow transplantation.Clin Transplant. 1995; 9: 205-208
- Octreotide acetate longacting formulation vs. open-label subcutaneous octreotide acetate in malignant carcinoid syndrome.J Clin Oncol. 1999; 17: 600-606
- Effect of a long-acting somatostatin analogue SMS 201-995 on jejunostomy effluents in patients with severe short bowel syndrome.Gut. 1989; 30: 943-949
- Somatostatin and its analogs in the short bowel syndrome.Nutr Clin Pract. 1992; 7: 81-85
- Octreotide Long-acting Formulation (LAR) in Chronic Loperamide-refractory Diarrhea Not Related to Cancer Treatment.Anticancer Res. 2006; 26: 2325-2328
- Long-term results of treatment of malignant carcinoid syndrome with prolonged release Lanreotide Autogel (Somatuline® Autogel).Aliment Pharmacol Ther. 2011; 34: 235-242
- Successful treatment of diabetic autonomic diarrhoea with monthly subcutaneous lanreotide Autogel.Pract Diab Int. 2009; 26: 326-328
- Octreotide in the treatment of refractory diarrhea and intestinal fistulae.Gut. 1994; 3: 5-10
- Octreotide in the treatment of refractory diarrhea.Digestion. 1999; 60: 42-46
- Gastrointestinal Neuroendocrine Tumors.Ann Gastroenterol. 2003; 16: 34-39
- Characterization of health related quality of life (HRQOL) for patients with functional bowel disorder (FBD) and its response to treatment.Am J Gastroenterol. 2007; 102: 1442-1453
Somatuline® Depot labeling revision 12/22/2014 Reference ID: 3677425 http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/022074s010lbl.pdf. Accessed April, 2016
Somatuline® Autogel®. Summary of product characteristics (SmPC). https://www.medicines.org.uk/emc/medicine/25104. April, 2016.
- Patient-reported satisfaction with symptom control during lanreotide Autogel Autogel/Depot treatment for carcinoid syndrome in gastroenteropancreatic neuroendocrine tumor patients: SYMNET, a large multinational, cross-sectional observational study.J Clin Oncol. 2014; 32 (abstr 273)
- Effect of lanreotide Autogel, a somatostatin analogue, on postprandial gastric functions and biliopancreatic secretions in humans.Br J Clin Pharmacol. 1997; 43: 65-70
- Lanreotide Autogel in metastatic enteropancreatic neuroendocrine tumors.N Engl J Med. 2014; 371: 224-233
- Systematic review: the use of somatostatin or octreotide in refractory diarrhoea.Aliment Pharmacol Ther. 2001; 15: 1889-1897
Article info
Publication history
Published online: July 13, 2016
Accepted:
June 15,
2016
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.