Treatment of psoriasis with chronic subcutaneous administration of somatostatin analog 201–995 (Sandostatin)
Charles Camisa, MDAddress reprint requests to C.C., Department of Dermatology, The Cleveland Clinic Foundation, One Clinic Center, 9500 Euclid Avenue, Cleveland, Ohio 44195.
Gretchen E Schacht, MD
Thomas M. O'dorisio, MD
Ronald E Maceyko, MD
Nine patients with psoriasis vulgaris were treated for 12 weeks with somatostatin analog, octreotide acetate (SMS 201–995) 50 or 100 μg by subcutaneous injection every 12 hours. The purposes of the study were to determine: (1) levels of insulin, glucose, glucagon, pancreatic polypeptide (PP), and SMS 201–995 after a subcutaneous injection of SMS 201–995 and ingestion of a standardized meal; (2) nocturnal (0200 h) thyroid stimulating hormone (TSH) levels before, during, and after treatment; and (3) the pharmacokinetics of SMS 201–995. Insulin peaks at 30 minutes were blunted from 65.8 ± 11.0 μU/mL without treatment to 26.7 ± 8.6 μU/mL and 7.7 ± 2.0 μU/mL after the 50- and 100-μg doses, respectively. Glucagon levels remained constant during the meal and were not affected by the 50-μg dose. Mean glucose levels were significantly elevated during insulin suppression. PP was also rapidly suppressed by SMS 201–995 and remained so for 4 hours after the injection. Nocturnal TSH was blunted after 12 weeks of treatment (P ≤ .05). T4 and T3 resin uptake showed no depression, and patients remained clinically euthyroid. The plasma peak of SMS 210–995 occurred 30 minutes postinjection and half-life was longer than 2 hours. After chronic administration of SMS 201–995, insulin was suppressed with resultant mild carbohydrate intolerance that persisted throughout the treatment course.