medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-10-115-122medsovet-6938Research ArticleДРУГИЕ ПРОБЛЕМЫ ЭНДОКРИНОЛОГИИOTHER PROBLEMS OF ENDOCRINOLOGYЗамена октреотида пролонгированного действия на ланреотид 120 мг у больных акромегалией в реальной клинической практикеReplacement of prolonged-acting octreotide with lanreotide autogel 120 mg in patients with Acromegaly in real clinical practicehttps://orcid.org/0000-0003-4013-4831ЦойУ. А.TsoyU. A.

Цой Ульяна Александровна, кандидат медицинских наук, заведующая научно-исследовательской лабораторией нейроэндокринных опухолей Центра персонализированной медицины

197341, Санкт-Петербург, ул. Аккуратова, д. 2

Uliana A. Tsoy, Cand. Sci. (Med.), Head of Research Laboratory of Neuroendocrine Tumours, Centre for Personalized Medicine

2, Akkuratov St., St Petersburg, 197341

utsoi@mail.ruhttps://orcid.org/0000-0003-3124-1512КравчукЕ. Н.KravchukE. N.

Кравчук Екатерина Никодимовна, кандидат медицинских наук, старший научный сотрудник научно-исследовательской лаборатории нейроэндокринных опухолей Центра персонализированной медицины

197341, Санкт-Петербург, ул. Аккуратова, д. 2

Ekaterina N. Kravchuk, Cand. Sci. (Med.), Senior Research Associate, Research Laboratory of Neuroendocrine Tumours, Centre for Personalized Medicine

2, Akkuratov St., St Petersburg, 197341

kravchuke@gmail.comhttps://orcid.org/0000-0001-6077-7477ДалматоваA. Б.DalmatovaA. B.

Далматова Анна Борисовна, кандидат медицинских наук, ассистент кафедры эндокринологии Института медицинского образования

197341, Санкт-Петербург, ул. Аккуратова, д. 2

Anna B. Dalmatova, Cand. Sci. (Med.), Teaching Assistant, Department of Endocrinology, Institute of Medical Education

2, Akkuratov St., St Petersburg, 197341

dalmatova.anna@mail.ruhttps://orcid.org/0000-0002-8616-1790БелоусоваЛ. В.BelousovaL. V.

Белоусова Лидия Викторовна, заведующая эндокринологическим отделением

197341, Санкт-Петербург, ул. Аккуратова, д. 2

Lidia V. Belousova, Head of Department of Endocrinology

2, Akkuratov St., St Petersburg, 197341

belousova-vis@mail.ruhttps://orcid.org/0000-0003-0042-7680ГриневаЕ. Н.GrinevaE. N.

Гринева Елена Николаевна, доктор медицинских наук, профессор, главный научный сотрудник научно-исследовательской лаборатории нейроэндокринных опухолей Центра персонализированной медицины

197341, Санкт-Петербург, ул. Аккуратова, д. 2

Elena N. Grineva, Dr. Sci. (Med.), Professor, Chief Research Associate, Research Laboratory of Neuroendocrine Tumours, Centre for Personalized Medicine, Director of Institute of Endocrinology

2, Akkuratov St., St Petersburg, 197341

grineva_e@mail.ruНациональный медицинский исследовательский центр имени В.А. АлмазоваРоссияAlmazov National Medical Research CentreRussian Federation202219062022010115122Copyright © Цой У.А., Кравчук Е.Н., Далматова A.Б., Белоусова Л.В., Гринева Е.Н., 20222022Цой У.А., Кравчук Е.Н., Далматова A.Б., Белоусова Л.В., Гринева Е.Н.Tsoy U.A., Kravchuk E.N., Dalmatova A.B., Belousova L.V., Grineva E.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6938Введение

Введение. При неэффективности нейрохирургического лечения акромегалии показана медикаментозная терапия аналогами соматостатина (АС) октреотидом или ланреотидом. Эффективность АС ограничена наличием резистентности. Существует мнение, что вариантом преодоления частичной резистентности к этим препаратам может быть замена одного препарата на другой.

Цель

Цель. Сделать анализ собственного опыта перевода больных акромегалией с терапии препаратами октреотида пролонгированного действия на ланреотид 120 мг.

Материалы и методы

Материалы и методы. Были проанализированы истории болезни пациентов с акромегалией, которым была рекомендована замена терапии препаратами октреотида медленного высвобождения на терапию ланреотидом 120 мг. Была оценена динамика показателей ГР и инсулиноподобного фактора роста 1 (ИФР-1). Целевыми значениями для ГР считали показатель менее 2,5 мкг/л, для ИФР-1 – превышение не более чем на 30% от верхней границы нормы.

Результаты

Результаты. 24 пациентам был рекомендован перевод на терапию ланреотидом 120 мг. Из 19 пациентов с недостаточным снижением ГР и ИФР-1 на терапии препаратами октреотида пролонгированного действия в дозе 40 мг (ОКТ40) после перевода на терапию ланреотидом в дозе 120 мг 1 раз в 28 дней (ЛАН120) целевые значения ГР и ИФР-1 были достигнуты в четырех (21%) случаях. У этих пациентов было не более чем двукратное превышение ИФР-1, а уровень ГР был меньше 2,5 мкг/л на фоне терапии ОКТ40. У 6 (32%) пациентов уровень ИФР-1 нормализовался или снизился, но ГР оставался вне целевых значений. В 9 (47%) случаях замена препарата АС не привела к значимой положительной динамике ГР и ИФР-1. Также в статье представлены результаты перевода пяти пациентов, получавших терапию октреотидом в дозе 20 мг (ОКТ20), на ланреотид в дозе 120 мг.

Выводы

Выводы. Эффективная замена ОКТ40 на ЛАН120 возможна у части больных акромегалией. Предиктором успеха может быть небольшое повышение уровня ИФР-1 на фоне целевых значений ГР перед заменой АС.

Introduction

Introduction. In the cases of neurosurgery failure in acromegaly treatment, drug therapy with somatostatin analogues (SSA) octreotide or lanreotide is indicated. The effectiveness of SSA is limited by the presence of resistance, there is an opinion that in some cases it can be overcome by replacing one drug with another.

Aim

Aim. Own experience analysis of transferring acromegaly patients from therapy with long-acting octreotide to lanreotide autogel 120 mg.

Materials and methods

Materials and methods. The case histories of acromegaly patients who were recommended to replace long-acting octreotide therapy with lanreotide therapy 120 mg were analyzed. GH and insulin-like growth factor-1 (IGF-1) dynamics was evaluated at least 6 months after the replacement of the drug. The target value for GH was considered to be less than 2.5 micrograms/l, for IGF-1 – an excess of no more than 30% of the upper normal limit.

Results

Results. 24 patients were transferred to lanreotide therapy 120 mg. Of the 19 patients with insufficient reduction of GH and IGF-1 on prolonged-acting octreotide therapy at a dose of 40 mg every 28 days (OCT40) the prescription of lanreotide 120 mg every 28 days (LAN120) led to the target values of both GH and IGF-1 in 4 (21%) cases. These patients had no more than a twofold excess of IGF-1, and the level of GH was less than 2.5 mcg/l on the background of OCT 40 therapy. In 6 (32%) patients, IGF-1 levels normalized or decreased, but GH remained outside the target values. In 9 (47%) cases, the replacement of the SSA did not lead to a significant positive dynamics in the levels of GH and IGF-1. The effects of lanreotide therapy 120 mg in another five patients initially treated with octreotide 20 mg are also described.

Conclusions

Conclusions. Replacement of OCT4 with LAN120 may be effective in some patients with acromegaly. A slight increase in the level of IGF-1 together with the target values of GH before replacing the SSA may be the predictor of success.

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The authors declare that there are no conflicts of interest present.