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Long‐term results of cabergoline therapy for macroprolactinomas and analyses of factors associated with remission after withdrawal
Author(s) -
Watanabe Shinya,
Akutsu Hiroyoshi,
Takano Shingo,
Yamamoto Tetsuya,
Ishikawa Eiichi,
Suzuki Hiroaki,
Matsumura Akira
Publication year - 2017
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13240
Subject(s) - cabergoline , medicine , prolactinoma , retrospective cohort study , urology , gastroenterology , prolactin , hormone
Summary Objective Withdrawal of cabergoline is generally challenging, especially in patients with large or invasive macroprolactinomas. Therefore, we aimed to assess long‐term results of cabergoline therapy for macroprolactinomas and remission achievement results after withdrawal in patients with macroprolactinomas. We also investigated clinical characteristics and factors related to remission after withdrawal. Methods This was an institutional review board‐approved retrospective analysis. We studied 46 macroprolactinoma patients who had taken cabergoline during the period from 2003 through 2013. Administration of cabergoline was maintained for 5 years before withdrawal. Results Median follow‐up after the initiation of cabergoline therapy was 54·3 (range 5·3 to 137·2) months. Recurrences of hyperprolactinaemia were observed in 3 of 11 (27%) postwithdrawal patients at a median time of 3·0 (range; 2·9–11·2) months, indicating that a high percentage (73%) maintained remission for at least 12 months after cabergoline cessation. Factors significantly associated with remission were analysed in 21 patients receiving long‐term cabergoline administration. On multivariate analysis, the absence of cavernous sinus invasion on pretreatment MRI (≥3/4 tumour encasement of the intracavernous internal carotid artery) ( HR ; 21·94, 95% CI ; 2·06–1071·0, P = 0·006), initial PRL <132·7 ng/ml ( HR ; 8·28, 95% CI ; 1·24–199·6, P = 0·03) and nadir PRL <1·9 ng/ml during cabergoline therapy ( HR ; 5·14, 95% CI ; 1·10–39·02, P = 0·04) showed statistically significant correlations with remission after withdrawal. Conclusions Cabergoline therapy can achieve a high percentage (73% in this series) of remission maintenance for at least 12 months after cessation of a 5‐year course of therapy, even in patients with macroprolactinomas. The absence of cavernous sinus invasion, serum PRL level lower than 132·7 ng/ml before cabergoline therapy or nadir serum PRL below 1·9 ng/ml were related to more frequent remission after withdrawal of cabergoline in patients receiving this medication for 5 years.