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Published on: April 17, 2019
Real-World Observational Study of Somatostatin Analogs and Rescue Medication Usage for Neuroendocrine Tumors in
Daniel Rayson1, Myriam Troesch2, Callahan LaForty3
1Division of Medical Oncology, Dalhousie University, Halifax, Nova Scotia, Canada, daniel.rayson@nshealth.ca.
Introduction:
Neuroendocrine tumors (NETs) are uncommon malignancies with increasing incidence in Canada. Long-acting somatostatin analogs (SSA) such as Lanreotide Autogel® (LAN-ATG) and Octreotide Long-Acting Release (OCT-LAR) are first-line treatments for well-differentiated gastroenteropancreatic neuroendocrine tumors either with or without carcinoid syndrome. Despite their efficacy, many patients require short-acting SSA for breakthrough symptoms. We investigated the impact of switching between long-acting SSAs on the usage of breakthrough medications and the incidence of above maximum recommended dose (AMRD) prescriptions.
Methods:
This population-based study used claims data from the IQVIA Canadian Private Drug Plan (PDP) that includes data from all Canadian provinces and public drug programs from Ontario and Québec. We identified NET patients who switched SSAs between September 2015 and December 2021. We analyzed breakthrough medication usage and AMRD prescriptions before and after the switch.
Results:
Among 170 patients who switched SSAs, there was a 59.1% overall reduction in breakthrough medication claims post-switch. Patients switching from OCT-LAR to LAN-ATG experienced a 66.5% reduction, while those switching from LAN-ATG to OCT-LAR saw a 21.9% decrease. Pre-switch, significantly more patients on OCT-LAR exceeded the AMRD threshold compared to those on LAN-ATG (43.8% vs. 18.2%, p value = 0.008).
Conclusion:
Switching between long-acting SSAs can reduce the need for breakthrough medications and lower the incidence of AMRD prescriptions, with a more pronounced effect observed when switching from OCT-LAR to LAN-ATG. These findings have potential implications for improving quality of life and reducing treatment costs for NET patients, which should be evaluated in a formal health economic analysis.
Insights
Switching long-acting somatostatin analogs (SSAs) for neuroendocrine tumors (NETs) significantly reduced breakthrough medication use. Switching from Octreotide Long-Acting Release (OCT-LAR) to Lanreotide Autogel (LAN-ATG) showed the greatest benefit.
Area of Science:
- Oncology
- Pharmacology
- Health Economics
Background:
- Neuroendocrine tumors (NETs) are increasing in incidence in Canada.
- Long-acting somatostatin analogs (SSAs), Lanreotide Autogel (LAN-ATG) and Octreotide Long-Acting Release (OCT-LAR), are first-line treatments for gastroenteropancreatic NETs (GEP-NETs).
- Patients often require short-acting SSAs for breakthrough symptoms despite current treatments.
Purpose of the Study:
- To investigate the impact of switching between long-acting SSAs on breakthrough medication usage.
- To assess the effect of switching SSAs on prescriptions exceeding the maximum recommended dose (AMRD).
Main Methods:
- Population-based study using Canadian IQVIA Private Drug Plan (PDP) claims data (September 2015 - December 2021).
- Identified 170 NET patients who switched between LAN-ATG and OCT-LAR.
- Analyzed breakthrough medication claims and AMRD prescriptions before and after the switch.
Main Results:
- Overall reduction of 59.1% in breakthrough medication claims post-switch.
- Patients switching from OCT-LAR to LAN-ATG experienced a 66.5% reduction in breakthrough claims.
- Pre-switch, 43.8% of OCT-LAR patients exceeded AMRD compared to 18.2% of LAN-ATG patients (p=0.008).
Conclusions:
- Switching between long-acting SSAs can decrease breakthrough medication needs and AMRD prescriptions.
- Switching from OCT-LAR to LAN-ATG demonstrated a more pronounced reduction in breakthrough medication use.
- Findings suggest potential improvements in NET patient quality of life and reduced treatment costs.
