Real-World Observational Study of Somatostatin Analogs and Rescue Medication Usage for Neuroendocrine Tumors in Canada

Introduction: Neuroendocrine tumors (NETs) are uncommon malignancies with increasing incidence in Canada. Long-acting somatostatin analogs (SSAs) such as Lanreotide Autogel (LAN-ATG) and Octreotide Long-Acting Release (OCT-LAR) are first-line treatments for well-differentiated GEP-NETs either with or without carcinoid syndrome (CS). Despite their efficacy, many patients require short-acting SSAs for breakthrough symptoms. We investigated the impact of switching between long-acting SSAs on the usage of breakthrough medications and the incidence of above maximum recommended dose (AMRD) prescriptions. Methods: This population-based study used claims data from the IQVIA Canadian Private Drug Plan (PDP) that includes data from all Canadian provinces and public drug programs from Ontario and Québec. We identified NET patients who switched SSAs between September 2015 and December 2021. We analyzed breakthrough medication usage and AMRD prescriptions before and after the switch. Results: Among 170 patients who switched SSAs, there was a 59.1% overall reduction in breakthrough medication claims post-switch. Patients switching from OCT-LAR to LAN-ATG experienced a 66.5% reduction, while those switching from LAN-ATG to OCT-LAR saw a 21.9% decrease. Pre-switch, significantly more patients on OCT-LAR exceeded the AMRD threshold compared to those on LAN-ATG (43.8% vs. 18.2%, p value = 0.008). Conclusion: Switching between long-acting SSAs can reduce the need for breakthrough medications and lower the incidence of AMRD prescriptions, with a more pronounced effect observed when switching from OCT-LAR to LAN-ATG. These findings have potential implications for improving quality of life and reducing treatment costs for NET patients, which should be evaluated in a formal health economic analysis.