Use of somatostatin analogues in gastrointestinal angiodysplasias refractory to other treatments
Abstract The most common vascular malformation of the digestive tract are gastrointestinal angiodysplasias. They are characterized by a venocapillary dilation with high vascular fragility, a pathological state that results in gastrointestinal bleeding. The prevalence increases in elderly and multi-pathological patients, which conditions the treatment and prognosis of angiodysplasias.The objective is to evaluate the efficacy of the treatment of angiodysplasias with somatostatin analogues, being these Octreotide and Lanreotide (outside of the technical data sheet for the indication), under conditions of usual clinical practice. In addition, we will try to relate the therapeutic response with the location of the lesions, comorbidities, readmissions, blood transfusions and prescription of anticoagulants.A retrospective observational study was carried out with data obtained from patients treated at the Complejo Asistencial Universitario de León. After the statistical analysis of the data, it was concluded that there are no significant differences between the drugs. There was also no significant association of success with the locations of the angiodysplasias, nor with the coexisting comorbidities, nor with the taking of anticoagulants. Only long-term treatments (> 11 months) are related to objective indicators of success, such as reducing the number of transfusions and re-admissions.
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Ramos-Rosario H, Badia Aranda E, Martín Lorente JL, Arias García L, Sicilia Aladrén B, Sáez-Royuela F. E?cacia de lanreótido en pacientes con angiodisplasias gastrointestinales refractarias al tratamiento con octreótido. Gastroenterol Hepatol. 2016; 39(3):213-214. - https://doi.org/10.1016/j.gastrohep.2015.02.008
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Scaglione G, Pietrini L, Russo F, Franco MR, Sorrentini I. Long-acting octreotide as rescue therapy in chronic bleeding from gastrointestinal angiodysplasia. Aliment Pharmacol Ther. 2007; 26(6):935-942. - https://doi.org/10.1111/j.1365-2036.2007.03435.x
Swanson E, Mahgoub A, MacDonald R, Shaukat A. Medical and Endoscopic Therapies for Angiodysplasia and Gastric Antral Vascular Ectasia: A Systematic Review. Clin Gastroenterol Hepatol. 2014; 12(4):571-582. - https://doi.org/10.1016/j.cgh.2013.08.038
Blich M, Fruchter O, Edelstein S, Edoute Y. Somatostatin therapy ameliorates chronic and refractory gastrointestinal bleeding caused by diffuse angiodysplasia in a patient on anticoagulation therapy. Scand J Gastroenterol. 2003; 38(7): 801-803. - https://doi.org/10.1080/00365520310001969
Bon C, Aparicio T, Vincent M, Mavros M, Bejou B, Raynaud JJ, et al. Long-acting somatostatin analogues decrease blood transfusion requirements in patients with refractory gastrointestinal bleeding associated with angiodysplasia. Aliment Pharmacol Ther. 2012; 36(6):587-593. - https://doi.org/10.1111/apt.12000
Brown C, Subramanian V, Mel Wilcox C, Peter S. Somatostatin Analogues in the Treatment of Recurrent Bleeding from Gastrointestinal Vascular Malformations: An Overview and Systematic Review of Prospective Observational Studies. Dig Dis Sci. 2010; 55(8):2129-2134. - https://doi.org/10.1007/s10620-010-1193-6
De La Peña Trigueros M, Gutiérrez Macías A, Estrada Vicente R, Miguel de la Villa F. Utilidad del octreótido long-acting release en el sangrado digestivo de origen oscuro. Gac Med Bilbao. 2011; 108(2):57-59. - https://doi.org/10.1016/j.gmb.2011.03.002
Jackson CS, Gerson LB. Management of Gastrointestinal Angiodysplastic Lesions (GIADs): A Systematic Review and Meta-Analysis. Am J Gastroenterol. 2014; 109(4):474-483. - https://doi.org/10.1038/ajg.2014.19
Jackson CS, Strong R. Gastrointestinal Angiodysplasia. Diagnosis and Management. Gastrointest Endosc Clin N Am. 2017; 27(1):51-62. - https://doi.org/10.1016/j.giec.2016.08.012
Molina IJ, Pérez GB, Fernández Bermejo M. Avances en el tratamiento farmacológico de la hemorragia digestiva de origen oscuro. Rev Esp Enferm Dig. 2007; 99(8):457-462. - https://doi.org/10.4321/S1130-01082007000800006
Molina IJ, Pérez GB, Hernández AM, Mateos Rodríguez J, Dueñas SC, Fernández Bermejo M. Octreótido long acting release para la hemorragia digestiva en pacientes de edad avanzada con comorbilidad. Med Clin (Barc). 2009; 133(17):667-670. - https://doi.org/10.1016/j.medcli.2009.07.013
Nardone G, Rocco A , Balzano T , Budillon G . The efficacy of octreotide therapy in chronic bleeding due to vascular abnormalities of the gastrointestinal tract. Aliment Pharmacol Ther. 1999; 13(11):1429-1436. - https://doi.org/10.1046/j.1365-2036.1999.00647.x
Ramos-Rosario H, Badia Aranda E, Martín Lorente JL, Arias García L, Sicilia Aladrén B, Sáez-Royuela F. E?cacia de lanreótido en pacientes con angiodisplasias gastrointestinales refractarias al tratamiento con octreótido. Gastroenterol Hepatol. 2016; 39(3):213-214. - https://doi.org/10.1016/j.gastrohep.2015.02.008
Sandoval Riveros C, Lúquez Mindiola A, Marulanda Fernández H, Otero Regino W. Sangrado del intestino delgado: enfoque y tratamiento. Rev Col Gastroenterol. 2017; 32(3):245-257. - https://doi.org/10.22516/25007440.156
Scaglione G, Pietrini L, Russo F, Franco MR, Sorrentini I. Long-acting octreotide as rescue therapy in chronic bleeding from gastrointestinal angiodysplasia. Aliment Pharmacol Ther. 2007; 26(6):935-942. - https://doi.org/10.1111/j.1365-2036.2007.03435.x
Swanson E, Mahgoub A, MacDonald R, Shaukat A. Medical and Endoscopic Therapies for Angiodysplasia and Gastric Antral Vascular Ectasia: A Systematic Review. Clin Gastroenterol Hepatol. 2014; 12(4):571-582. - https://doi.org/10.1016/j.cgh.2013.08.038
Villa Del Bosque, G., Álvarez Núñez, N., Domínguez Carbajo, A. B., & Ortega Valín, L. (2019). Use of somatostatin analogues in gastrointestinal angiodysplasias refractory to other treatments. FarmaJournal, 4(2), 61–72. https://doi.org/10.14201/fj2019426172
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