Octreotide in the management of diarrhea induced by graft versus host disease.

OBJECTIVE

To evaluate the potential benefit of the somatostatin analogue, octreotide, for the management of diarrhea induced by graft versus host disease (GVHD).

METHODS

Pilot clinical trial involving 21 patients undergoing allogeneic transplant with positive histologic or radiographic evidence of GVHD of the gastrointestinal tract who failed antidiarrheal therapy with loperamide.

RESULTS

A complete response, defined as resolution of diarrhea, was seen in 71% of trial participants (15 of 21 patients). At the dose and scheduling used (500 mcg i.v. three times daily for a median of seven consecutive days), octreotide was extremely well tolerated in all patients.

CONCLUSIONS

In this pilot study, octreotide treatment was effective in reducing the amount of diarrhea in patients with acute GVHD. The data suggest that patients receiving octreotide early in the course of the diarrhea experienced more benefit than patients with persistent diarrhea prior to receiving octreotide. The demonstrated safety and efficacy of octreotide in this patient population support further investigation of this therapeutic strategy for GVHD-induced diarrhea. A randomized, controlled, clinical trial of octreotide versus loperamide for the initial treatment of GVHD-induced diarrhea is warranted.

CONCLUSIONS

Octreotide should be administered early in the course of GVHD as soon as onset of diarrhea is noted and should be discontinued as soon as diarrhea resolves to avoid constipation and the potential development of an ileus. Because response to the drug usually occurs quickly, maintaining treatment for additional days or weeks is unnecessary. If a benefit is not seen in four to seven days, continuing octreotide therapy is neither cost-effective nor prudent.