Patterns of somatostatin receptor ligand dosage and titration in patients with acromegaly: a real-world evidence study

M. Fleseriu*a (Dr), S. Melmedb (Dr), A. Ribeiro-Oliveira Jrc (Dr), M. Del Pilar Schneiderd (Dr), Y. Darhie (Mr), T. Bruef (Dr), A. Barkang (Dr)

a Oregon Health and Science University, Portland, UNITED STATES ; b University of California, Los Angeles, Los Angeles, UNITED STATES ; c Ipsen, Cambridge, UNITED STATES ; d Ipsen, Les Ulis, FRANCE ; e Ipsen, Boulogne-Billancourt, FRANCE ; f Aix-Marseille University, Marseille, FRANCE ; g University of Michigan, Ann Arbor, UNITED STATES

* fleseriu@ohsu.edu

Aim

Evaluate medication dosing and titration in patients with acromegaly receiving octreotide long-acting release (OCT) or lanreotide depot (LAN) injections.

Material and methods

Acromegaly is a rare disease caused by excess growth hormone secretion, for which somatostatin receptor ligands such as OCT or LAN are generally recommended as first-line treatments.1 However, real‑world studies evaluating usage of these medications are limited.

De-identified patient data were extracted from MarketScan®, a US claims database (01/01/2010-05/31/2020). Eligible patients received monotherapy acromegaly treatment for ≥90 days, had no prescription gaps >3 months and had dosage information available.

Outcomes included the proportion of patients with: treatment uptitration (increase in dose or injection frequency); dose uptitration above the approved dose; and an extended dose interval (EDI; prescription of OCT [≤30 mg] or LAN [≤120 mg] of six or eight weeks), per each treatment.

Results

Of the patients prescribed OCT (n=117), most (70.9%) received 20 mg every 4 weeks (q4week). Of the patients prescribed LAN (n=155), most (69.0%) received 90 mg q4week.

Few patients used the maximum dose approved of either therapy; more patients receiving OCT started on a higher-than-approved dose (>30 mg; 12.8%) than those receiving LAN (>120 mg; 1.3%). Dose uptitration occurred for 17.1% vs 15.5% of patients on OCT vs LAN monotherapy, respectively.

A low proportion of patients receiving OCT or LAN used an EDI (4.3% [95% CI: 1.4%-9.7%] vs 7.1% [95% CI: 3.6%-12.3%], respectively).

Discussion

While more patients receiving OCT vs LAN started on a higher-than-approved dose, the few patients receiving the maximum dose of either treatment may indicate that acromegaly is usually well-managed with intermediate doses of monotherapy treatment, or that physicians infrequently uptitrate medication dosage after treatment initiation.

Few patients receiving LAN used EDIs, despite evidence that EDIs with LAN 120 mg provide similar biochemical control to standard dosing intervals for patients whose hormone levels are well-controlled.2,3 These results suggest EDIs may be underused in eligible patients, in whom they might reduce burden of injections and healthcare costs.

Bibliography

  1. Acromegaly. NHS. 2020.
  2. Somatuline® autogel®. Summary of product characteristics. 2021.
  3. Bernabéu I. Endocrine 2020.

The author has declared the following conflict(s) of interest:

Maria Fleseriu received a research grant to Oregon Health and Science University as principal investigator for Amryt, Crinetics, Ionis, and Recordati and served as an occasional scientific consultant or advisory board member for Amryt, Crinetics, Ionis, Ipsen, Pfizer and Recordati.

Shlomo Melmed received consulting fees from Novo Nordisk, Recordati Rare Diseases and Ionis; received an educational grant from Ipsen; serves as the secretary for the Pituitary Society; and received a grant to the University of California, Los Angeles from Pfizer.

Antonio Ribeiro-Oliveira Jr is an employee of Ipsen and holds stock in Ipsen.

Maria del Pilar Schneider is an employee of Ipsen.

Yannis Darhi is an employee of Ipsen.

Thierry Brue received funding and medical writing support from Ipsen; received consulting fees from Ipsen, Recordati, Novartis and Pfizer; received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Recordati, Novartis and Ipsen; received support for attending meetings and/or travel from Ipsen and Pfizer; participated on a Data Safety Monitoring Board or Advisory Board for Advanz Pharma and Recordati; and received a grant to Aix-Marseille University from Pfizer.

Ariel Barkan has no conflicts of interest to disclose.