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Somatostatin analogues compared to placebo and other pharmacological agents in the management of symptoms of inoperable malignant bowel obstruction: a systematic review

Obita, George P.; Boland, Elaine G.; Currow, David C.; Johnson, Miriam J.; Boland, Jason W.

Authors

George P. Obita

Elaine G. Boland

David C. Currow

Jason W. Boland

Abstract

Context Somatostatin analogues are commonly used to relieve symptoms in malignant bowel obstruction (MBO) but are more expensive than other antisecretory agents. Objectives To evaluate the evidence of effectiveness of somatostatin analogues compared with placebo and/or other pharmacologic agents in relieving vomiting in patients with inoperable MBO. Methods MEDLINE, EMBASE, CINAHL, and The Cochrane Controlled Trials Register databases were systematically searched; reference lists of relevant articles were hand searched. Cochrane risk of bias tool was used. Results The search identified 420 unique studies. Seven randomized controlled trials (RCTs) met the inclusion criteria (six octreotide studies and one lanreotide); 220 people administered somatostatin analogues and 207 placebo or hyoscine butylbromide. Three RCTs compared a somatostatin analogue with placebo and four with hyoscine butylbromide. Two adequately powered multicenter RCTs with a low Cochrane risk of bias reported no significant difference between somatostatin analogues and placebo in their primary end points. Four RCTs with a high/unclear Cochrane risk of bias reported that somatostatin analogues were more effective than hyoscine butylbromide in reducing vomiting. Conclusion There is low-level evidence of benefit with somatostatin analogues in the symptomatic treatment of MBO. However, high-level evidence from trials with low risk of bias found no benefit of somatostatin analogues for their primary outcome. There is debate regarding the clinically relevant study end point for symptom control in MBO and when it should be measured. The role of somatostatin analogues in this clinical situation requires further adequately powered, well-designed trials with agreed clinically important end points and measures.

Journal Article Type Review
Publication Date 2016-12
Journal Journal of pain and symptom management
Print ISSN 0885-3924
Electronic ISSN 1873-6513
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 52
Issue 6
Pages 901-919
Institution Citation Obita, G. P., Boland, E. G., Currow, D. C., Johnson, M. J., & Boland, J. W. (2016). Somatostatin analogues compared to placebo and other pharmacological agents in the management of symptoms of inoperable malignant bowel obstruction: a systematic review. Journal of pain and symptom management, 52(6), (901-919). doi:10.1016/j.jpainsymman.2016.05.032. ISSN 0885-3924
DOI https://doi.org/10.1016/j.jpainsymman.2016.05.032
Keywords Inoperable malignant bowel obstruction, Palliative care, Somatostatin analogues, Ocreotide, Randomised controlled trial, Vomiting
Publisher URL http://www.sciencedirect.com/science/article/pii/S0885392416303244
Additional Information This article is maintained by: Elsevier; Article Title: Somatostatin Analogues Compared With Placebo and Other Pharmacologic Agents in the Management of Symptoms of Inoperable Malignant Bowel Obstruction: A Systematic Review; Journal Title: Journal of Pain and Symptom Management; CrossRef DOI link to publisher maintained version: http://dx.doi.org/10.10...painsymman.2016.05.032; Content Type: article; Copyright: © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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