Double-blind, placebo-controlled, randomized trial of octreotide in malignant bowel obstruction

Currow, D.C., Quinn, S., Agar, M., Fazekas, B., Hardy, J., McCaffrey, N., Eckermann, S., Abernethy, A.P. and Clark, K. (2015) Double-blind, placebo-controlled, randomized trial of octreotide in malignant bowel obstruction. Journal of Pain and Symptom Management, 49 5: 814-821. doi:10.1016/j.jpainsymman.2014.09.013


Author Currow, D.C.
Quinn, S.
Agar, M.
Fazekas, B.
Hardy, J.
McCaffrey, N.
Eckermann, S.
Abernethy, A.P.
Clark, K.
Title Double-blind, placebo-controlled, randomized trial of octreotide in malignant bowel obstruction
Journal name Journal of Pain and Symptom Management   Check publisher's open access policy
ISSN 1873-6513
0885-3924
Publication date 2015-05-01
Year available 2015
Sub-type Article (original research)
DOI 10.1016/j.jpainsymman.2014.09.013
Open Access Status Not yet assessed
Volume 49
Issue 5
Start page 814
End page 821
Total pages 8
Place of publication Philadelphia, PA, United States
Publisher Elsevier
Language eng
Abstract Context. Does octreotide reduce vomiting in cancer-associated bowel obstruction?
Formatted abstract
Context
Does octreotide reduce vomiting in cancer-associated bowel obstruction?

Objectives
To evaluate the net effect of adding octreotide or placebo to standardized therapies on the number of days free of vomiting for populations presenting with vomiting and inoperable bowel obstruction secondary to cancer or its treatment.

Methods
Twelve services enrolled people with advanced cancer presenting with vomiting secondary to bowel obstruction where surgery or anti-cancer therapies were not indicated immediately. In a double-blind study, participants were randomized to placebo or octreotide (600 μg/24 hours by infusion). Both arms received standardized supportive therapy (infusion of ranitidine [200 mg/24 hours], dexamethasone [8 mg/24 hours], and parenteral hydration [10–20 mL/kg/24 hours]). The primary outcome was patient-reported days free of vomiting at 72 hours.

Results
In a study that recruited to the numbers identified in its power calculation, 87 participants provided data at 72 hours (45, octreotide arm). Seventeen people (octreotide) and 14 (placebo) were free of vomiting for 72 hours (P = 0.67). Mean days free of vomiting were 1.87 (SD 1.10; octreotide) and 1.69 (SD 1.15; placebo; P = 0.47). An adjusted multivariate regression of the incidence of vomiting over the study showed a reduced number of episodes of vomiting in the octreotide group (incidence rate ratio = 0.40; 95% CI: 0.19–0.86; P = 0.019); however, people in the octreotide arm were 2.02 times more likely to be administered hyoscine butylbromide (P = 0.004), potentially reflecting increased colicky pain.

Conclusion
Although there was no reduction in the number of days free of vomiting, the multivariate analysis suggests that further study of somatostatin analogues in this setting is warranted.
Keyword Malignant bowel obstruction
Net clinical benefit
Octreotide
Palliative care
Randomized controlled trial
Vomiting
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: Mater Research Institute-UQ (MRI-UQ)
 
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