medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-10-148-152medsovet-6942Research ArticleДРУГИЕ ПРОБЛЕМЫ ЭНДОКРИНОЛОГИИOTHER PROBLEMS OF ENDOCRINOLOGYOктреотид в лечении акромегалии – возможности высокодозной медикаментозной терапииOctreotide in the treatment of acromegaly – the possibilities of high-dose therapyhttps://orcid.org/0000-0003-3261-7366ИловайскаяИ. А.IlovayskayaI. A.

Иловайская Ирэна Адольфовна, доктор медицинских наук, доцент, руководитель отделения нейроэндокринных заболеваний, профессор курса частной эндокринологии при кафедре эндокринологии факультета усовершенствования врачей

129110, Москва, ул. Щепкина, д. 61/2, корп. 1

 

Irena A. Ilovayskaya, Dr. Sci. (Med.), Associate Professor, Head of the Department of Neuroendocrine Diseases, Professor of the Course of Private Endocrinology at the Department of Endocrinology of the Faculty of Advanced Medical Training

61/2, Bldg. 1, Schepkin St., Moscow, 129110

irena.ilov@yandex.ruМосковский областной научно-исследовательский клинический институт имени М.Ф. ВладимирскогоРоссияMoscow Regional Research and Clinical Institute named after M.F. VladimirskiyRussian Federation202220062022010148152Copyright © Иловайская И.А., 20222022Иловайская И.А.Ilovayskaya I.A.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/6942

Октреотид – аналог соматостатина первого поколения, который 40 лет используется для медикаментозного лечения акромегалии как после нейрохирургического вмешательства, так и в качестве первой линии лечения. Частота биохимического контроля на фоне применения октреотида продленного действия варьирует от 25 до 56% в зависимости от уровней гормона роста и ИРФ-1 в дебюте заболевания, наличия предыдущего хирургического вмешательства, пола и возраста пациента, соблюдения режима лечения и применяемой дозы октреотида. Многолетний клинический опыт применения октреотида продленного действия демонстрирует, что более чем у половины пациентов требуется увеличение дозировки до 30 мг и выше. Если на фоне лечения октреотидом в дозе 30 мг в течение 3 мес. не отмечается нормализации уровня ИРФ-1, но произошло его снижение на 50% и более от исходного, возможно дальнейшее увеличение дозы до 40 мг, т. к. при этом повышается эффективность лечения без увеличения частоты побочных эффектов. Зарубежными исследователями было показано, что высокие дозы октреотида (60 мг каждые 28 дней) могут улучшать показатели биохимического контроля у пациентов, не полностью ответивших на терапию дозами 30–40 мг октреотида продленного действия. Необходимы дальнейшие исследования для определения оптимальной дозы октреотида продленного действия в терапии акромегалии как на старте лечения, так и в его процессе. Ведение пациентов группой специалистов, занимающихся лечением опухолей гипофиза, позволит быстрее достичь биохимического контроля акромегалии.

Octreotide is a first-generation somatostatin analog that has been used for 40 years for the medical treatment of acromegaly, both after neurosurgical intervention and as first-line treatment. The frequency of biochemical control against the background of extended-acting octreotide varies from 25 to 56% depending on growth hormone and IGF-1 levels at the disease debut, presence of previous surgery, patient gender and age, treatment compliance and the dose of octreotide used. Longterm clinical experience with prolonged-acting octreotide demonstrates that more than half of patients require an increase in dosage to 30 mg or higher. If during treatment with Octreotide in a dose of 30 mg for 3 months there is no normalization of IGF-1 level, but there was a decrease of 50% or more of the initial level, further dose increase to 40 mg is possible, because this increases the effectiveness of treatment without increasing the frequency of side effects. Foreign researchers have shown that high doses of Octreotide (60 mg every 28 days) can improve biochemical control in patients who have not fully responded to therapy with doses of 30–40 mg of extended-acting Octreotide. Further studies are needed to determine the optimal dose of prolonged octreotide in acromegaly therapy, both at the start of treatment and during treatment. Management of patients by a team of specialists involved in the treatment of pituitary tumors will allow faster achievement of biochemical control of acromegaly.

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