Case report: Optimizing the transition from injectable to oral treatment for acromegaly

Abstract

We report 3 cases of patients with acromegaly in whom surgical treatment did not achieve permanent biochemical control and in whom adjuvant pharmacotherapy with injectable somatostatin receptor ligands (iSRLs) was required but was either refused, poorly tolerated, or resulted in breakthrough symptoms of acromegaly. Therefore, treatment was transitioned to twice-daily oral octreotide capsules (OOC), formulated to enable enhanced absorption of octreotide to therapeutic levels through tight intracellular junctions in the intestine.Transition to OOC resulted in biochemical control of acromegaly and symptom improvement in all 3 cases. Additionally, the two patients transitioning from iSRLs reported increased treatment satisfaction with OOC compared with their previous therapy. OOC adverse effects were primarily gastrointestinal, including diarrhea, nausea, and bloating, and either subsided after several weeks of OOC treatment or were manageable with dietary changes.These case reports indicate that OOC may be an effective and tolerable therapy for patients with acromegaly. Moreover, transitioning patients with acromegaly from iSRLs to OOC may increase adherence to adjuvant pharmacotherapy by eliminating painful injections and injection site reactions, decreasing breakthrough symptoms, improving treatment convenience, and increasing patient satisfaction with therapy.

Keywords

• Acromegaly
• Case report
• Injectable somatostatin receptor ligands
• Oral octreotide capsules
• Therapy transition