Context Chronic abdominal pain is the most difficult management issue in patients with chronic pancreatitis. Recently, a long-acting depo-formulated version of octreotide has been developed that can be given as a once monthly intramuscular injection, Octreotide LAR® (O-LAR) rather than as a thrice daily subcutaneous injection (octreotide short-acting, O-SA). Objective To see if O-LAR is similar in efficacy to O-SA in the treatment of painful chronic pancreatitis in a small open-label, unblinded pilot study. Patients Seven advanced chronic pancreatitis patients with daily, severe abdominal pain who had previously responded to O-SA were recruited from the pancreas clinics of the University of Florida and monitored for one month on O-SA and for four months while on O-LAR. Each patient served as his/her own control as this was a paired data set. Main outcome measures 1) Daily VAS scores; 2) daily morphine equivalents; 3) monthly health related quality of life chronic pancreatitis surveys; 4) daily diaries of work/pleasurable activities missed or hospitalization/Emergency Department visits. Results Average daily VAS scores for patients during O-SA therapy were 4.50±2.28 and during the fourth month of O-LAR therapy, 3.86±2.11, difference -0.64±0.80 (P=0.078). Average daily morphine equivalents were not dissimilar at 124.3±177.3 mg during O-SA therapy and 131.6±194.3 mg during O-LAR therapy; difference 7.3±17.5 mg P=0.310. Health related quality of life chronic pancreatitis scores were not significantly changed when moving from O-SA to O-LAR. Adverse events were rare. Conclusions Octreotide LAR® may be a reasonable substitute for tid octreotide in treating chronic pancreatitis pain. Further, larger studies would be useful to better characterize the role of Octreotide LAR® in the management of chronic pancreatitis pain.
John G Lieb II, Jonathan J Shuster, Douglas Theriaque, Cheryl Curington, Miriam Cintr?n, Phillip P Toskes