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        New Message Board Archives >> Medications, Treatments, Therapies 2004 >> Fresh Research - Octreotide to Abort
        
(Message started by: floridian on Sep 30^th, 2004, 8:18am)

Title: Fresh Research - Octreotide to Abort
Post by floridian on Sep 30^th, 2004, 8:18am

Octreotide, a drug similar to the natural hormone somatostatin, has value in aborting cluster headaches. Although it is statistically significant, the benefits are not huge (52% in the octreotide group vs. 36% in the placebo group, a real rate on the order of 16%). But this shows that somatostatin-like drugs do help, which may give insight into how the beast does his damage. It is also possible that other somatostatin-like drugs could be more effective.

Quote:

Ann Neurol. 2004 Sep 28;56(4):488-494. [Epub ahead of print]

Subcutaneous octreotide in cluster headache: Randomized placebo-controlled double-blind crossover study.

Matharu MS, Levy MJ, Meeran K, Goadsby PJ.

Headache Group, Institute of Neurology, Queen Square, London, United Kingdom.

Current practical evidence-based acute treatments of cluster headache are limited to subcutaneous and intranasal formulations of sumatriptan, and oxygen. Two small randomized, double-blind trials suggested efficacy of somatostatin in cluster headache. We sought to determine whether octreotide, a somatostatin analog, is effective in the abortive treatment of acute cluster headache. Patients with episodic and chronic cluster headache, as defined by the International Headache Society, were recruited to a double-blind placebo-controlled crossover study. Patients were instructed to treat two attacks of at least moderate pain severity, with at least a 24-hour break, using subcutaneous octreotide microg or matching placebo. The primary end point was the headache response defined as very severe, severe, or moderate pain becomes mild or nil, at 30 minutes. The primary end point was examined using a multilevel analysis approach. A total of 57 patients were recruited of whom 46 provided efficacy data on attacks treated with octreotide and 45 with placebo. The headache response rate with subcutaneous octreotide was 52%, whereas that with placebo was 36%. Modeling the treatment outcome as a binomial where response was determined by treatment, using the patient as the level 2 variable, and considering period effect, sex, and cluster headache type as other variables of interest, we found that the effect of subcutaneous octreotide 100microg was significantly superior to placebo (p < 0.01). Subcutaneous octreotide 100microg is effective in the acute treatment of cluster headache when compared with placebo. Nonvasconstrictor treatment of acute cluster headache is possible.

Title: Re: Fresh Research - Octreotide to Abort
Post by Kevin_M on Sep 30^th, 2004, 8:42am

on 09/30/04 at 08:18:55, floridian wrote:

It is also possible that other somatostatin-like drugs could be more effective.

Looks promising. Good to see a new angle of attack being looked at and worked on that has a positive affect.
Any info to share about somatostatin hormone?

Kevin M

Title: Re: Fresh Research - Octreotide to Abort
Post by floridian on Sep 30^th, 2004, 9:42am

Quote:

Somatostatin was first discovered in hypothalamic extracts and identified as a hormone that inhibited secretion of growth hormone. Subsequently, somatostatin was found to be secreted by a broad range of tissues, including pancreas, intestinal tract and regions of the central nervous system outside the hypothalamus.

Somatostatin acts by both endocrine and paracrine pathways to affect its target cells. A majority of the circulating somatostatin appears to come from the pancreas and gastrointestinal tract. If one had to summarize the effects of somatostatin in one phrase, it would be: "somatostatin inhibits the secretion of many other hormones".

Effects on the Pituitary Gland

Somatostatin was named for its effect of inhibiting secretion of growth hormone from the pituitary gland. Experimentally, all known stimuli for growth hormone secretion are suppressed by somatostatin administration. Additionally, animals treated with antisera to somatostatin show elevated blood concentrations of growth hormone, as do animals that are genetically engineered to disrupt their somatostatin gene.

Ultimately, growth hormone secretion is controlled by the interaction of somatostatin and growth hormone releasing hormone, both of which are secreted by hypothalamic neurons.

Effects on the Pancreas

Cells within pancreatic islets secrete insulin, glucagon and somatostatin. Somatostatin appears to act primarily in a paracrine manner to inhibit the secretion of both insulin and glucagon. It also has the effect in suppressing pancreatic exocrine secretions, by inhibiting cholecystokinin-stimulated enzyme secretion and secretin-stimulated bicarbonate secretion.

Effects on the Gastrointestinal Tract

Somatostatin is secreted by scattered cells in the GI epithelium, and by neurons in the enteric nervous system. It has been shown to inhibit secretion of many of the other GI hormones, including gastrin, cholecystokinin, secretin and vasoactive intestinal peptide.

In addition to the direct effects of inhibiting secretion of other GI hormones, somatostatin has a variety of other inhibitory effects on the GI tract, which may reflect its effects on other hormones, plus some additional direct effects. Somatostatin suppresses secretion of gastric acid and pepsin, lowers the rate of gastric emptying, and reduces smooth muscle contractions and blood flow within the intestine. Collectively, these activities seem to have the overall effect of decreasing the rate of nutrient absorption.

Effects on the Nervous System

Somatostatin is often referred to has having neuromodulatory activity within the central nervous sytem, and appears to have a variety of complex effects on neural transmission. Injection of somatostatin into the brain of rodents leads to such things as increased arousal and decreased sleep, and impairment of some motor responses.

http://arbl.cvmbs.colostate.edu/hbooks/pathphys/endocrine/otherendo/somatostatin.html

Title: Re: Fresh Research - Octreotide to Abort
Post by Kevin_M on Sep 30^th, 2004, 10:04pm

Thanks.

;)

Kevin M

Title: Re: Fresh Research - Octreotide to Abort
Post by Pinkfloyd on Oct 2^nd, 2004, 2:58pm

"The primary end point was examined using a multilevel analysis approach. A total of 57 patients were recruited of whom 46 provided efficacy data on attacks treated with octreotide and 45 with placebo."

I assume they gave each person some shots of "A" and some of "B" and were asked to report on how each injection worked. (either that or they can't add LOL)
I wonder what the heck happened to the 11 people that didn't report anything. Why sign up if you aren't going to report back. Hope they didn't die ;-) That's 20% of the people not reporting anything, which could have changed the end results dramatically.

36% efficacy rate for the placebo is on the high end for placebos which leads me to believe that their 30 minute primary end point was getting close to the normal length of attacks for a significant percentage of patients (10-15%).

Nice to see some thinking "outside the box"

PF

Title: Re: Fresh Research - Octreotide to Abort
Post by floridian on Oct 18^th, 2004, 10:24am

Bump.