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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Effects of lanreotide SR and Autogel on tumor mass in patients with acromegaly: a systematic review

G Mazziotti and A Giustina.

Review published: 2010.

Link to full article: [Journal publisher]

CRD summary

This review examined data on the tumour shrinkage effects of long-acting lanreotide in patients with acromegaly. It concluded that lanreotide was able to quite frequently induce tumour shrinkage, particularly when used as first-line therapy. Because of several reporting limitations, it is not possible to determine the reliability of this conclusion.

Authors' objectives

To review the data on the tumour shrinkage effects of long-acting lanreotide in patients with acromegaly.

Searching

The PubMed database was searched alongside the reference lists of textbooks and retrieved articles, and abstracts of relevant meetings up to November 2008. Search terms were not reported.

Study selection

Randomised controlled trials (RCTs), prospective and retrospective non-randomised studies that evaluated the effects of long acting lanreotide (lanreotide SR or lanreotide Autogel) on adenoma size in patients with acromegaly resulting from growth hormone-secreting pituitary adenomas were eligible for inclusion in the review.

Among included studies, the definition of tumour shrinkage (where defined) ranged from 10 to 50% reduction in volume, 25% reduction in diameter, or 18% reduction in area. Most studies evaluated lanreotide SR. Studies included patients receiving lanreotide as a primary or secondary treatment; previous treatments included neurosurgery, radiotherapy and drugs.

The authors did not state how the papers were selected for inclusion or how many reviewers performed the selection.

Assessment of study quality

The authors did not state that they assessed validity.

Data extraction

Data were extracted on the proportion of patients with tumour shrinkage as defined in the primary study.

The authors did not state how many reviewers performed the extraction.

Methods of synthesis

Studies were combined in a narrative synthesis. The influence of treatment type (primary or secondary) and type of adenoma (micro or macro) was discussed as was the association between shrinkage and biochemical response.

Results of the review

A total of 22 studies (n=826 patients) were included in the review, of which 21 (n=801 patients) reported the proportion of patients experiencing tumour shrinkage.

Overall a total of 32.8% of patients experienced a variable degree (10 to 77%) of tumour shrinkage using lanreotide SR or Autogel treatment.

Eight studies that used lanreotide SR or Autogel as a primary treatment reported shrinkage in 29 to 100% of patients. One study (n=118 patients) reported higher rates of tumour shrinkage in a primary compared to secondary treatment group (22% versus 5.9%). Three studies reported shrinkage in 9 to 42% of patients receiving lanreotide as secondary treatment.

A single RCT (n=12 patients) directly compared lanreotide SR with octreotide LAR and found no significant difference in shrinkage between the treatments.

Authors' conclusions

Lanreotide, particularly when used as first-line therapy, was able to quite frequently induce tumour shrinkage in patients with acromegaly.

CRD commentary

The review question was reasonably well-defined in terms of the participants, interventions, outcomes and study designs of interest. One electronic database plus other sources were searched for relevant evidence, although it was unclear whether the search was limited by language of publication. The authors did not mention any attempts to minimise the potential for errors or bias during the conduct of the review.

No attempt was made to assess the relative quality of included studies. It was not clear how the pooled outcomes were calculated.

Given these reporting limitations, it is not possible to determine the reliability of the authors' conclusions.

One of the authors disclosed financial links with several pharmaceutical companies, including Ipsen, the manufacturers of lanreotide (marketed as somatuline).

Implications of the review for practice and research

Practice: The authors stated that lanreotide may have a role in the primary treatment of acromegaly

Research: The authors did not state any implications for research

Funding

Not stated.

Bibliographic details

Mazziotti G, Giustina A. Effects of lanreotide SR and Autogel on tumor mass in patients with acromegaly: a systematic review. Pituitary 2010; 13(1): 60-67. [PubMed: 19189218]

Indexing Status

Subject indexing assigned by NLM

MeSH

Acromegaly /drug therapy /pathology /therapy; Antineoplastic Agents; Humans; Octreotide /therapeutic use; Peptides, Cyclic /pharmacology /therapeutic use; Somatostatin /analogs & derivatives /pharmacology /therapeutic use; Tumor Burden /drug effects

AccessionNumber

12010002813

Database entry date

15/09/2010

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 19189218

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