ECE2015 Eposter Presentations Pituitary: basic and neuroendocrinology (62 abstracts)
Progressive reduction of tolvaptan doses in the treatment of chronic SIADH
Teresa Ruiz-Gracia 1 , Ana Ortolá 1 , Irene Crespo 1 , Alejando Santiago 1 , Emilia Gomez-Hoyos 2 , Lourdes Recio 1 , Martin Cuesta 3 , Maria Paz Pacheco 1 , Alfonso Calle-Pascual 1 & Isabelle Runkle 1
1Hospital Clínico San Carlos, Madrid, Spain; 2Hospital Clinico de Valladolid, Valladolid, Spain; 3Beaumont Hospital, Dublin, Ireland.
Introduction: Chronic tolvaptan (TV) therapy has been found to be safe and effective in the treatment of chronic SIADH. However, experience with modification of doses over time is limited.
Methods: We conducted a retrospective analysis of weekly TV doses (mg) in 41 patients with chronic SIADH treated for a minimum of 3 months, seen a week following discharge and monthly thereafter. Serum sodium (SNa) goal was 137–140 mmol/l, with 50% TV dose reduction when SNa ≥141 and increase when SNa <137. SNa (mmol/l) corrected for glycemia/total proteins. Kruskal–Wallis, Mann–Whitney U, SPSS15.
Results: 25/41(61%) women, median age of 76 (67–85). Median Nadir SNa: 119 (S.D.: 6.2). Etiology of SIADH: idiopathic 12/41 (29.3%), oncological 10/41 (24.4)%, pulmonary 7/41 (17.1%), pharmacological 5/41 (12.2%), neurological 5/41 (12.2%), and others 2/41 (4.9%). Average duration of therapy was 18.4 (S.D.: 12.0) months. Median weekly hospital discharge dose: 105 (105–105) with SNa 137 (S.D.: 3.0); at 1 month: 105 (78.7–105), SNa 139 (S.D.: 3.3); at 3 months: 52.5 (26.3–135), SNa 138 (S.D.: 3.7); at 6 months: 52.5 (25.3–88.1), SNa 139 (S.D.: 3.3); and at 1 year: 37.5 (22.5–105), SNa 138 (S.D.: 2.7). Oncological patients needed higher doses when compared to the rest at discharge: 157.5 (105–210) vs 105 (105–105), P=0.049; at 3 months: 210 (52.5–236.2) vs 52.5 (26.3–105), P=0.021; and at 6 months 105 (52.5–420) vs 52.5 (22.5–75), P=0.022. Pharmacological patients needed lower doses when compared to the rest at 3 months: 26.25 (18.8–65.6) vs 52.5 (52.5–198.8), P=0.042, at 6 months 22.5 (7.5–37.5) vs 52.5 (28.1–105), P=0.010, and at 1 year 22.5 (11.3–28.1) vs 52.5 (30–105), P=0.024. Side effects: 1/41 patients presented persistent thirst. None presented elevation of liver enzymes.
Conclusions: Chronic tolvaptan therapy is safe and can maintain strict eunatremia in patients with chronic SIADH. Progressively lower doses are needed, thus contributing to economic sustainability of therapy. The minimum dose is usually attained after 6 months of therapy. Oncological patients require higher doses, and pharmacological patients lower ones.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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