CLINICAL QUESTION: Does octreotide long-acting release (LAR) reduce transfusion requirements in patients with angiodysplasia-related anemia?
BACKGROUND: Angiodysplasias frequently cause refractory bleeding and anemia, particularly in elderly patients. While thalidomide and endoscopic ablation have been used to treat this condition, the side effects of the former and the high rebleeding rate (one-third within two years) of the latter leave much to be desired. A recent meta-analysis suggested that octreotide LAR improves hemoglobin levels and decreases transfusion needs, though prior studies were limited by small sample sizes and retrospective designs.
STUDY DESIGN: Multicenter, open-label, randomized, controlled trial SETTING: 17 hospitals in the Netherlands
SYNOPSIS: In this study, 62 patients who had received at least four units of red blood cells or parenteral iron infusions in the preceding year were randomized 1:1 over one year to either 40 mg of octreotide LAR intramuscularly every 28 days or standard care, including endoscopic therapy. Of note, the majority of patients were elderly (mean age, 72 years), had angiodysplasias located in the small bowel (87%), had been tried on thalidomide (over 65%), and were on antiplatelet therapy (45%) or anticoagulation (29%). The total number of transfusions was lower with octreotide compared with standard of care (11.0 versus 21.2), and octreotide reduced the annual volume of endoscopic procedures by 0.9 (95% CI, 0.3 to 1.5). Limitations included the lack of blinding and between-group differences that had to be controlled for with analyses of covariance.
BOTTOM LINE: Octreotide LAR effectively reduced transfusion requirements and the need for endoscopic interventions in patients with angiodysplasia-related anemia. The authors concluded that octreotide could be considered a beneficial treatment option for managing this tough condition.
CITATION: Goltstein LCMJ, et al. Standard of care versus octreotide in angiodysplasia-related bleeding (the OCEAN study): a multicenter randomized controlled trial. Gastroenterology. 2024;166(4):690-703. doi: 10.1053/j.gastro.2023.12.020.
Dr. Giordano
Dr. Giordano is a hospitalist at Duke Regional Hospital and a medical instructor at the Duke University School of Medicine, both in Durham, N.C.