Efficacy of octreotide-LAR in dieting women with abdominal obesity and polycystic ovary syndrome

Somatostatin, an endogenous hypothalamic peptide, lowers circulating levels of luteinizing hormone (LH), growth hormone, and insulin. The presence of somatostatin receptors at both the ovarian and adrenal levels suggests that somatostatin analogs may be effective as a treatment for polycystic ovary syndrome (PCOS). This study evaluated one of these analogs, octreotide-LAR, a long-acting formulation, versus placebo, in 20 overweight or obese women with PCOS, 18 of whom completed the study. Octreotide has been shown to lower levels of LH, insulin, insulin-like growth factor-I (IGF-I), and androgen. It also has enhanced spontaneous and stimulated ovulation in women with PCOS. The present patients received a low-calorie diet for 1 month, after which 10 mg octreotide-LAR or placebo was injected every 28 days for 6 months. All women complied with treatment and tolerated it well. Body weight, body mass index, and waist circumference decreased, but differences from the placebo patients were not significant. Testosterone and androstenedione levels declined significantly only in actively treated patients. Both fasting and stimulated insulin levels decreased during treatment with octreotide-LAR, whereas levels of IGF-binding protein-2 (IGFBP-2) and IGFBP-3 increased. Hirsutism improved with active treatment but not in women given placebo. All women given octreotide but only one placebo recipient had ovulated by the end of the trial. Acanthosis nigricans decreased during treatment. Octreotide treatment was associated with significantly higher levels of estradiol and progesterone. One octreotide-treated woman conceived spontaneously in the second cycle after treatment stopped. Long-term benefit is observed in women with PCOS who, in addition to dieting, take octreotide-LAR over the long term. Ovulation is restored to otherwise anovulatory patients. The treatment is well-tolerated and safe.