Somatostatin Analogue Therapy in Patients with Gastrointestinal Angiodysplasias

Stomach
Stomach, computer illustration.
Investigators assessed the safety and efficacy of somatostatin analogue therapy on red blood cell transfusion requirements in patients with gastrointestinal angiodysplasias.

In most patients with red blood cell transfusion-dependent bleeding due to gastrointestinal angiodysplasias, somatostatin analogue therapy is safe and effective, according to a study published in The Lancet Gastroenterology & Hepatology.

Somatostatin analogues possess anti-angiogenic effects; therefore, they have become an alternative treatment modality to endoscopic argon plasma coagulation in patients with gastrointestinal angiodysplasias. Researchers conducted a systematic review and individual patient data meta-analysis to investigate the efficacy of somatostatin analogues on red blood cell transfusion requirements in patients with gastrointestinal angiodysplasias. They aimed to characterize subgroups that might benefit the most from somatostatin analogue therapy.

Investigators identified 11 eligible studies and analyzed data from 212 patients. They found that somatostatin analogues reduced the number of red blood cell transfusions from 12.8 during baseline to 2.3 during follow-up (a reduction of 10.5 red blood cell transfusions; P <.0001).

Eighty-three percent (177/212) of patients had a good response to somatostatin analogue therapy; however, the location of gastrointestinal angiodysplasias in the stomach compared with angiodysplasias in the small bowel and colon was associated with a worse treatment response. In addition, octreotide was associated with a better treatment response than lanreotide therapy.

Adverse events occurred in 18% (38/212) of patients receiving somatostatin analogue therapy, with 5% discontinuing therapy because of these events. The most common adverse events were loose stools, cholelithiasis, flatulence, and administration site reactions.

This study was limited by a risk for bias, as some studies included in the analysis had a retrospective design or lacked a control group. Additionally, data on the number of angiodysplasias each patient had were unavailable, limiting the investigators’ ability to assess bleeding severity.  

“In conclusion, somatostatin analogue therapy is safe and effective in most patients with red blood cell transfusion-dependent bleeding due to gastrointestinal angiodysplasias,” stated the authors. “Treatment is more effective in patients with angiodysplasias located in the small bowel and colon, and octreotide therapy seems to be more effective than lanreotide therapy,” they concluded.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Lia C M J Goltstein, Karina V Grooteman, Alba Rocco, et al. Effectiveness and predictors of response to somatostatin analogues in patients with gastrointestinal angiodysplasias: a systematic review and individual patient data meta-analysis. Lancet Gastroenterol Hepatol. 2021;6(11):922-932. doi: 10.1016/S2468-1253(21)00262-4