Octreotide-LAR Delays Cyst Growth in ADPKD Patients

Satyanarayana Vaidya, MD

Octreotide-LAR treatment could be beneficial to patients suffering from autosomal dominant polycystic kidney disease (ADPKD).

In a poster presented at the American Society of Nephrology (ASN) Kidney Week in Washington, D.C., investigators, led by Satyanarayana Vaidya, MD, Emory School of Medicine, evaluated the efficacy of Octreotide-LAR on disease progression based on a meta-analysis of published literature across all stages of chronic kidney disease due to ADPKD.

The team identified all placebo-controlled randomized trials of Octreotide-LAR through a literature search and analyzed the efficacy—rate of cyst growth and kidney function decline—as well as safety outcomes.

Ultimately, they found 4 trials that fulfilled the requirements, with a total of 445 patients.

The results showed were positive for Octreotide-LAR.

“Compared to placebo, Octreotide-LAR showed a significant reduction of total kidney volume, standard mean difference -.41[ 95% CI, -.69--0.12], P =.005 but a comparable mean reduction in glomerular filtration rate standard mean difference .01 [95% CI, -.17-.20], P =.90 and rate of adverse events RR, 1.46 [0.82-2.61], P =.20,” the authors wrote.

Participants in the trial were adults with a clinical and ultrasound diagnosis of ADPKD with glomerular filtration rate of ≥15 ml/min/1.73 m2, with the exclusion of diabetics and patients with poorly controlled hypertension (BP> 180/110 mmHg).

The outcomes included mean total kidney volume and decrease in glomerular filtration rate, compared using a standard mean difference.

ADPKD is the most common hereditary kidney disease, characterized by tubular epithelial cell proliferation (ECP) and fluid secretion leading to cystic kidney enlargement and progressive renal failure in the majority of cases.

The cyclic adenosine monophosphate (cAMP) pathway has been found in the past in both epithelial cell proliferation and fluid secretion.

Somatostatin and its synthetic analogues have shown in the past to inhibit invitro adenyl cyclase activity and slow cyst growth in both underpowered studies in either early or more advanced stages of ADPKD.

However, the study could yield better outcomes for patients with ADPKD.

“Octreotide-LAR delays the cyst growth across all stages of kidney disease in ADPKD, without a clear beneficial effect on kidney function, or a significant difference in adverse outcomes,” the authors wrote. “Longer follow-up is required to elucidate a potential beneficial role of Octreotide-LAR on kidney function.”