Impact of Somatostatin Analogs vs. Surgery on Glucose Metabolism in Acromegaly

Learn more about:
Related Clinical Trial
Rhinological Outcomes in Endonasal Pituitary Surgery Co-treatment With Pegvisomant and a Somatostatin Analogue (SA) in SA-responsive Acromegalic Patients Study to Allow Access to Pasireotide for Patients Benefiting From Pasireotide Treatment in Novartis-sponsored Studies A Four-Part Study to Assess the Safety, Tolerability, PK and PD of ONO-5788 in Healthy Adult Volunteers The Effect of Subcutaneous Infusions of 3 Doses of DG3173 on Growth Hormone Levels in Untreated Acromegalics One Year Follow-up of Study 2-79-52030-207 (PRIMARYS) in Acromegalic Patients With Macroadenoma Study in Polish Acromegalic Patients Treated With Somatuline Autogel Long Term Use of Somavert (Pegvisomant) For A Regulatory Post Marketing Commitment Plan Predictive Factors of Response to Somatostatin Analogues in Acromegalic Patients With Persistent Disease Following Surgery The Observational Study of Growth Hormone-secreting Pituitary Tumors Change in Quality of Life After Addition of Weekly 40 mg Pegvisomant/Placebo in Controlled Acromegalic Patients Study to Evaluate the Efficacy and Safety of Sandostatin LAR at High Dose or in Combination Either With GH-receptor Antagonist or Dopamine-agonist in Acromegalic Patients Efficacy and Safety of Lanreotide Autogel (60, 90 or 120 mg) in Acromegalic Patients Substrate Metabolism and Insulin Sensitivity in Acromegalic Patients Before and After Treatment Single-dose Study to Evaluate the Absolute Bioavailability and Mass Balance of ONO-5788 Study Comparing SOM230 Subcutaneously and Sandostatin Subcutaneously in Acromegalic Patients Therapeutic Strategies in Acromegalic Subjects Treated With Lanreotide 120mg Preoperative Lanreotide Treatment in Acromegalic Patients With Macroadenomas Study to Assess the Efficacy of an Extended Injection Interval Schedule of Lanreotide Autogel in Acromegalic Subjects Phase II Study With ITF2984 in Acromegalic Patients Non Interventional Study For Patients Treated With Somavert® Single Dose Pharmacology Study of DG3173 and Octreotide in Acromegalic Patients. Estrogen Treatment in Acromegalic Women Pharmacodynamics Of Product Octreotide Acetate Lar 30 Mg, Imported And Distributed By The Laboratory Chemical Pharmaceutical Bergamo Ltda., Compared To Product Sandostatin LAR ® (Octreotide Acetate LAR) 30 MG Manufactured By Novartis Biosciences S / A. ACRODAT Prospective Evaluation Study Pegvisomant And Sandostatin LAR Combination Study Lanreotide as Primary Treatment for Acromegalic Patients With Pituitary Gland Macroadenoma Open Label Extension Study Evaluating Safety and Biological Activity of C2L-OCT-01 PR in Acromegalic Patients Efficacy and Safety of C2L-OCT-01 PR in Acromegalic Patients Efficacy of Octreotide Acetate and Cabergoline in Patients With Acromegaly Canadian Pegvisomant Compassionate Study In Acromegalic Patients Efficacy and Safety Study of Varying Doses of Lanreotide Autogel in Patients With Acromegaly Hormonal Outcomes in Acromegalic Patients With Treated Surgery With or Without Long Acting Somatostatin Analogues Tissue Biomarker for Pegvisomant Action Sandostatin LAR Depot vs. Surgery for Treating Acromegaly Safety and Efficacy of Octreotide Long Acting Release (LAR) in Treatment Naïve Acromegalic Patients Lanreotide Autogel 120 mg at Extended Dosing Intervals (>4 Weeks) in Acromegalic Subjects Comparable Effects of Lanreotide Autogel and Octreotide LAR on GH, IGF-I Levels and Patient Satisfaction Predictive Factors Study Sleep Apnea Syndrome on Acromegaly: Impact of the Treatment on the Carbohydrates Metabolism. Growth Hormone Feedback to Insulin-like Growth Factor-I (IGF-1) and Oral Glucose Tolerance Test (OGTT) Somatostatin Analog Treatment of Acromegaly Before Pituitary Surgery : Comparison With Neurosurgery Alone Effect of 120mg Somatuline Autogel at Different Dose Intervals (28, 42 or 56 Days) in Patients With Acromegaly Acromegaly – Before and After Treatment Study to Assess the Efficacy and Safety of Repeated Administration of BIM 23A760 in Patients With Acromegaly Measurement of Outcome of Surgical Treatment in Patients With Acromegaly Non Interventional Post Marketing Programme in Acromegaly Short and Long Term Efficacy of Combined Cabergoline and Octreotide Treatment in Acromegalic Patients Cardiovascular Outcome After Surgery or Somatostatin Analogues Efficacy/Safety of Octreotide Acetate in Patients With Uncontrolled Acromegaly Study Assessing the Efficacy and Safety of Octreotide Acetate in Patients With Acromegaly, With Micro or Macroadenomas Long Term Study With B2036-PEG Octreotide Efficacy and Safety in First-line Acromegalic Patients Long-term Safety and Efficacy Study of Octreotide Implant in Patients With Acromegaly An Extension Study to Assess the Long-term Safety and Efficacy of Pasireotide in Patients With Acromegaly Study of the Effect of Growth Hormone-Releasing Hormone Antagonist on Growth Hormone Release in Acromegaly Clomiphene Citrate for Treatment of Acromegaly Cardiac (CMRI) Assessment of Acromegaly Acromegaly Combination Treatment Study Efficacy and Safety of Octreotide Capsules (MYCAPSSA) in Acromegaly Assessment of Changes in Metabolic Activity in Liver & Skeletal Muscle in Patients Suffering From Acromegaly Changes of Left Ventricular Mass and Cardiac Function in Patients With Active Acromegaly During Treatment With the Growth Hormone Receptor Antagonist Pegvisomant Assessment of BIM23B065, Given as Repeated Subcutaneous Injection in Subjects With Acromegaly A Study to Evaluate the Risk of Developing a Heart Condition Called Valvular Regurgitation in Patients With Acromegaly Treated With Either Lanreotide or Octreotide Pasireotide LAR and Pegvisomant Study in Acromegaly Effects of Sandostatin LAR® in Acromegaly Open Label Study of Octreotide Implant in Patients With Acromegaly Efficacy and Safety Study of Octreotide Implant in Patients With Acromegaly Somatuline Autogel: Acromegaly Self/Partner Injection Study A Study To Compare The Efficacy And Safety Of Pegvisomant To That Of Sandostatin Lar Depot In Patients With Acromegaly Efficacy and Tolerability of Lanreotide (Autogel 120 mg) in Patients With Acromegaly Study to Predict Lanreotide-induced Disease Activity Normalization in Acromegaly Impact of Somatostatin Analogs vs. Surgery on Glucose Metabolism in Acromegaly Prospective Study on Changes in Acromegaly Study to Determine the Maximum Tolerated Dose, Safety and Tolerability of a Single Dose of Lanreotide Prolonged Release Formulation (PRF) in Subjects With Acromegaly Dose Escalation of Octreotide-LAR as First-Line Therapy in Resistant Acromegaly Assessment of the Ability of Subjects With Acromegaly or Their Partners to Administer Somatuline Autogel Efficacy and Safety of Lanreotide Autogel® 60, 90 or 120 mg With Lanreotide 40 mg Prolonged Release (PR) in Acromegaly An Open-label, Multi-center, Expanded Treatment Protocol of Pasireotide LAR in Patients With Acromegaly Assessment of Airway in Patients With Acromegaly for Predicting Successful Tracheal Intubation Quality of Life (QoL) in Subjects With Acromegaly Under Lanreotide Autogel® Treatment. A Study to Evaluate the Long-Term Safety and Efficacy of Paltusotine for the Treatment of Acromegaly (ACROBAT Advance) An Study to Evaluate the Safety and Efficacy of Paltusotine for the Treatment of Acromegaly (ACROBAT Edge) Study to Evaluate Patients With Acromegaly Treated With Lanreotide Autogel (Somatuline ATG) IGF-I and Free Fatty Acids Isn Glucose Metabolism in Acromegaly Safety and Efficacy of Pasireotide Long Acting Release (LAR) vs. Octreotide LAR in Patients With Active Acromegaly Study of Management of Pasireotide-induced Hyperglycemia in Adult Patients With Cushing’s Disease or Acromegaly Growth Hormone, IGF-1 and Medical Treatment in Acromegaly: Are There Effects on Gut Hormone Physiology and Postprandial Substrate Metabolism? Efficacy and Safety of Pasireotide Long Acting Release (LAR) Versus Octreotide LAR or Lanreotide Autogel (ATG) in Patients With Inadequately Controlled Acromegaly Rehabilitation Program in Patients With Acromegaly Acute Application of Pegvisomant and Octreotide in Acromegaly Lanreotide Autogel-120 mg as First-Line Treatment of Acromegaly Prediction of Tumor Shrinkage in Acromegaly Somatostatin Analogue Treatment of Acromegaly: Molecular Aspects Safety and Efficacy of Long-acting Repeatable Octreotide Acetate for Injectable Suspension vs. Surgery in Treatment-naïve Patients With Acromegaly SAGIT for Classification of Patients With Acromegaly in Clinical Practice Lanreotide Autogel in Patients With Acromegaly Previously Treated With Octreotide LAR Olfactory Function and Olfactory Bulb Volume in Acromegaly Patients Late Effects of Radiosurgery on Acromegaly Study Ultrasound Guided Octreotide LAR Injection in Acromegaly Comparison of Oral Octreotide Capsules to Injectable Somatostatin Analogs in Acromegaly A Trial to Assess the Long-term Safety of Octreotide Subcutaneous Depot in Patients With Acromegaly Safety, Tolerability, and Efficacy of IONIS-GHR-LRx in Patients With Acromegaly Being Treated With Long-acting Somatostatin Receptor Ligands A Trial to Assess Efficacy and Safety of Octreotide Subcutaneous Depot in Patients With Acromegaly Strict IGF-1 Control in Acromegaly Extension Study of IONIS-GHR-LRx Administered to Participants With Acromegaly Being Treated With Long-acting Somatostatin Receptor Ligands Treatment of Acromegaly With Somatostatin Analogs: GH vs. IGF-I as Primary Biochemical Target Fractionated Stereotactic Radiotherapy in Patients With Acromegaly Validation Study of the SAGIT® Instrument in Acromegaly Developing a Simple Recognition System of Acromegaly Glucose Tolerance in Acromegaly: The Influence of GH-excess on Glucose Metabolism and Insulin Resistance Surgical Versus Medical Treatment of Acromegaly A Study to Evaluate the Safety and Efficacy of Paltusotine for the Treatment of Acromegaly (ACROBAT Evolve) Acromegaly & Sleep Apnoea Somatuline Predictive Factors in Acromegaly and NET Acromegaly Treatment Quality of Life Study Lanreotide Levels in Acromegaly Description of Sign-and-symptom Associations at Acromegaly Diagnosis. Treatment Patterns and Treatment Outcomes for Acromegaly Ectopic Lipid Deposition and Insulin Resistance in After Treatment of Acromegaly Physiopathology of Sodium Retention in Acromegaly Somatuline® Depot (Lanreotide) for Acromegaly Post-Marketing Observational Study Peri- and Post-operative Dynamics of the Growth Hormone Axis in Subjects With Acromegaly During the First Year After Surgical Resection The Longitudinal Approach to Acromegaly: A Pattern of Treatment and Comparative Effectiveness Research Preoperative Octreotide Treatment of Acromegaly The Treatment and Natural History of Acromegaly Bone MicroArchitecture in Acromegaly Reproducibility and Utility of OGTT in Acromegaly A Prospective Study of Outcome After Therapy for Acromegaly Epidemiology of Acromegaly in Denmark 1991-2010 Programme of Acromegaly Screening in Patients With Associated Somatic Disorders Acromegaly: Patient And Physician Perspectives

Brief Title

Impact of Somatostatin Analogs vs. Surgery on Glucose Metabolism in Acromegaly

Official Title

Impact of Somatostatin Analogs vs. Surgery on Glucose Metabolism in Acromegaly: Results of a 5 Years Observational, Open, Prospective Study

Brief Summary

      To investigate the 60 month impact of surgery and somatostatin analogues (SSA) on glucose
      metabolism in acromegaly we will analyzed data from 100 patients with acromegaly according
      with different treatments (group A=with SSA only; group B= SSA followed by surgery; group C=
      surgery only; group D= surgery followed by SSA). At diagnosis and after 6-12 and 60 months
      were analyzed as primary outcome measure changes in fasting glucose and as secondary outcome
      measures changes of glycated hemoglobin (HbA1c) and insulin levels, HOMA-R and HOMA-β,
      representing insulin resistance and β-cell function, respectively.

      We will enrol 100 patients and expect half of them to have IGT or diabetes mellitus. We do
      not expect changes according with different treatment after 60 months while SSA-treated
      patients might experience deterioration of glucose tolerance after 6-12 months. We intend to
      look for predictors of deterioration of glucose tolerance.
    

Detailed Description

      Impaired glucose tolerance (IGT) and overt diabetes mellitus are frequently associated with
      acromegaly. Patients with acromegaly are insulin resistant both in the liver and in the
      periphery, displaying hyperinsulinemia and increased glucose turn-over in the basal
      post-absorptive states. The prevalence of diabetes mellitus and that of IGT in acromegaly is
      unknown but is reported to range 19-56% and 16-46% in different series. The increased
      cardiovascular morbidity and mortality associated with acromegaly may party be a consequence
      of the increased insulin resistance that frequently accompanies GH excess. Glucose tolerance
      may worsen in patients treated with somatostatin analogues (SSA), because insulin secretion,
      i.e. β-cell function, is also suppressed. SSA induce control of GH and IGF-I excess in
      approximately 60% of patients after 12 months of treatment with no significant difference as
      applied after unsuccessful surgery or as first-line in newly diagnosed patients and control
      of GH and IGF-I levels occur with an even higher prevalence after a longer period of
      treatment. The inhibitory effect of SSA on pancreatic insulin secretion might, however,
      complicate the overall effect of this treatment on glucose tolerance. We recently
      demonstrated that 12 months after first-line treatment with SSA or surgery produced a similar
      improvement in LV hypertrophy and diastolic filling while systolic function increased more
      evidently in SSA-treated patients, total/HDL-cholesterol ratio significantly reduced only in
      SSA-treated patients while fasting glucose levels significantly reduced only in
      surgery-treated patients. A normal pituitary function was found in 46.4% of SSA-treated and
      in 36.4% of surgery-treated patients, resulting unchanged in the former and slightly reduced
      in the latter. Both a direct effect of SSA and a more preserved pituitary function might
      explain these results. Longitudinal data of glucose tolerance in patients with acromegaly and
      with or without diabetes treated long-term with SSA or surgery or both are still very
      limited.

      In order to investigate whether SSA negatively impact glucose tolerance in acromegaly, we
      will analyze data collected prospectively during a 10 year period. We will compare the
      results of glucose tolerance at diagnosis after 6-12 months and after 60 months of treatment
      with SSA or surgery. Patients will be grouped according with their treatment (SSA only,
      surgery only, SSA followed by surgery and SSA followed by surgery and SSA) in order to
      establish the effects on glucose tolerance mediated by disease control and type of treatment.
    


Study Type

Observational


Primary Outcome

Changes of fasting glucose levels.

Secondary Outcome

 changes in Hb1Ac levels changes in fasting insulin levels changes in HOMA-R index changes in HOMA-β index

Condition

Acromegaly

Intervention

Octreotide-LAR or lanreotide

Study Arms / Comparison Groups

 Group A
Description:  >15 patients treated only with SSA (octreotide-LAR or lanreotide depot)

Publications

* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.

Recruitment Information


Recruitment Status

Drug

Estimated Enrollment

100

Start Date

January 1997

Completion Date

June 2008

Primary Completion Date

June 2008

Eligibility Criteria

        Inclusion Criteria:

          -  Patients treated with either first-line surgery via trans-sphenoidal route by
             microscopic and/or endoscopic approach or with first-line depot SSA treatment, or both
             and

          -  Patients with available follow-up after 60 months of treatment

        Exclusion Criteria:

          -  Patients requiring dopamine-agonists or pegvisomant

          -  Patients receiving the s.c. octreotide for longer than 15 days

          -  Patients receiving radiotherapy,

          -  Patients with a follow-up shorter than 60 months
      

Gender

All

Ages

18 Years - 80 Years

Accepts Healthy Volunteers

No

Contacts

Annamaria Colao, MD, , 

Location Countries

Italy

Location Countries

Italy

Administrative Informations


NCT ID

NCT00703079

Organization ID

NeuroendoUnit-10



Study Sponsor

Federico II University


Study Sponsor

Annamaria Colao, MD, Principal Investigator, Federico II University


Verification Date

June 2008