Evaluating home injection compared with healthcare-setting injection of somatostatin analogs: a systematic literature review

Plain language summary Acromegaly and neuroendocrine tumors (NETs) are two diseases that affect the production of hormones, leading to a variety of symptoms in different parts of the body. Patients can be treated with medications called somatostatin analogs, which include lanreotide Autogel/Depot (LAN) and octreotide long-acting release (OCT). These treatments are given by injections, usually performed by a doctor or nurse in a healthcare setting such as a hospital or clinic. However, patients can sometimes receive LAN or OCT injections at home by a healthcare professional or-for LAN only-independently by a partner or the patient themself. Home injection may be less disruptive for patients and could free up healthcare resources, but there is limited evidence to support the choice. To address this, we reviewed all publications on home injection of somatostatin analogs in the last 20 years, finding 12 relevant studies. Results generally showed that home injections and injections in the healthcare setting had a similar effect on disease signs and symptoms, and were equally safe. Patients receiving home injections were also successfully able to follow the treatment plan prescribed by their doctor. Although some patients still preferred to receive injections in the healthcare setting, patients generally found injections at home more convenient. Home injections also resulted in lower costs as fewer appointments at the hospital or clinic were needed. The findings of this review indicate that injections of somatostatin analogs at home, instead of in the healthcare setting, could be a potential option for patients whose circumstances allow it. Purpose A systematic literature review was conducted to assess the use of home injections (self/partner/healthcare provider [HCP]-administered) of somatostatin analogs (SSAs) as an alternative to healthcare-setting injections in patients with acromegaly and neuroendocrine tumors (NETs). Methods MEDLINE/Embase/the Cochrane Library (2001-September 2021), key congresses (2019-2021), and bibliographies of relevant systematic reviews were searched. Eligible studies reported on efficacy/effectiveness, safety, adherence, patient-reported outcomes (PROs), and economic outcomes in populations receiving home injections of SSAs. Results Overall, 12 studies were included, all reporting on SSAs (lanreotide Autogel/Depot or octreotide long-acting release) in acromegaly or NETs. Across four studies, home injection was associated with similar disease control in patients with acromegaly/NETs compared with healthcare-setting administration. High rates of treatment adherence were shown in two studies of patients with acromegaly receiving lanreotide injections at home. Two studies reported non-serious adverse events; incidence of adverse reactions was similar in both the home and healthcare administration settings. Preference for injection setting varied between studies and indications; nonetheless, higher satisfaction/convenience (>75% patients) was reported for home injections. Self- or partner-injection was associated with economic savings compared with administration in the healthcare setting across five studies. Conclusion Efficacy/effectiveness, adherence, and safety outcomes of SSAs in the home injection setting were similar to those in the healthcare setting, with high reported satisfaction and convenience. Self/partner injection also resulted in cost savings. These findings provide a basis to understand outcomes related to home injection and encourage healthcare providers to discuss optimal treatment choices with their patients.

Automated summary

Home injections of somatostatin analogs have similar efficacy, safety, and adherence outcomes compared to healthcare-setting injections. Patients generally find injections at home more convenient and it also leads to cost savings.