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Comparative Efficacy and Safety of Octreotide, Lanreotide, and Pasireotide in Autosomal Dominant Polycystic Kidney
Ziwei Mei1, Jun Chen2, Junfen Fan3
1Department of Pharmacy, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Introduction:
Somatostatin analogs were the primary treatment of autosomal dominant polycystic kidney disease or polycystic liver disease, including octreotide, lanreotide, and pasireotide. This study aims to compare the efficacy and safety of three somatostatin analogs.
Methods:
We compared the effects and safety of octreotide, lanreotide, and pasireotide on total kidney volume (TKV), total liver volume (TLV), and kidney function in patients with autosomal dominant polycystic kidney disease or polycystic liver disease using network meta-analysis and FDA Adverse Event Reporting System data.
Results:
Pooled estimates from limited available trials suggested that, at 6 months or 1 year, octreotide (mean difference: -3.7, 95% CI: -4.3 to -3.2) and pasireotide (-5.0, -8.2 to -1.8) were associated with preliminary evidence of TKV reduction compared with placebo. However, lanreotide (-7.8, -10.2 to -5.4) obviously manifested a decrease in the TKV after more than 2 years. TLV analyses showed early directional effects of octreotide (-7.7, -12.1 to -3.3) and pasireotide (-9.0, -13.7 to -4.3) at 1 year, and for lanreotide (-5.0, -6.3 to -3.9) after more than 2 years. Lanreotide demonstrated inferior efficacy in reducing the TLV growth rate compared with octreotide (10.0, 2.7 to 18.0) after a 2-3 year administration period. Cholelithiasis is the most common biliary adverse event in 3 somatostatin analogs. Cox regression identified age (hazard ratio: 0.966, 95% CI: 0.949-0.982, P < 0.001) and drug (hazard ratio: 2.168, 95% CI: 1.411-3.332, P < 0.001) as independent predictors of cholelithiasis.
Discussion:
The onset time of TKV/TLV reduction differs among the 3 somatostatin analogs. Age and drug were independent predictors of cholelithiasis. Younger patients or those receiving pasireotide are at higher risk of cholelithiasis.
