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Effect of cabergoline monotherapy in Cushing's disease: an individual participant data meta-analysis.
Palui, R; Sahoo, J; Kamalanathan, S; Kar, S S; Selvarajan, S; Durgia, H.
Afiliación
  • Palui R; Department of Endocrinology, JIPMER, Fourth Floor, Superspecialty Block, Puducherry, 605006, India.
  • Sahoo J; Department of Endocrinology, JIPMER, Fourth Floor, Superspecialty Block, Puducherry, 605006, India. jppgi@yahoo.com.
  • Kamalanathan S; Department of Endocrinology, JIPMER, Fourth Floor, Superspecialty Block, Puducherry, 605006, India.
  • Kar SS; Department of Preventive and Social Medicine, JIPMER, Puducherry, India.
  • Selvarajan S; Department of Clinical Pharmacology, JIPMER, Puducherry, India.
  • Durgia H; Department of Endocrinology, JIPMER, Fourth Floor, Superspecialty Block, Puducherry, 605006, India.
J Endocrinol Invest ; 41(12): 1445-1455, 2018 12.
Article en En | MEDLINE | ID: mdl-30097903
CONTEXT: The primary treatment of choice for Cushing's disease (CD) is the removal of the pituitary adenoma by transsphenoidal surgery (TSS). The surgical failure is seen in up to 75% of cases depending on the experience of the surgeon in different studies. Medical therapy is one of the options for the treatment of recurrent or persistent CD. METHODOLOGY: The primary outcome of this meta-analysis was to find the proportion of patients achieving normalisation of 24-h urinary free cortisol (remission of CD) following cabergoline monotherapy. Literature search was conducted in January 2018 in PubMed/MEDLINE database from its date of inception to 31st December 2017. The search strategy used was "[(cushing) OR Cushing's] AND cabergoline". Individual participant data were extracted from the included studies and risk of bias was analysed by review checklist proposed by MOOSE. RESULTS: The individual participant data of 124 patients from six observational studies were included in this meta-analysis. 92 patients (74.2%) had past pituitary surgery. The proportion of patients achieving remission of Cushing's disease (CD) with cabergoline monotherapy was 34% (95% confidence interval 0.26­0.43; P = 0.001) [corrected]. The previous surgery [odds ratio (OR) 28.4], duration of cabergoline monotherapy (OR 1.31) and maximum cabergoline dose (OR 0.19) were predictors for remission of CD. Mild and severe side effects were reported in 37.3% and 5.6% of patients, respectively, during cabergoline monotherapy. CONCLUSIONS: This meta-analysis shows that cabergoline monotherapy is a reasonable alternative for subjects with persistent or recurrent CD after TSS. It can also be used in CD patients either as a bridge therapy while waiting for surgery or in those unwilling for surgery or have contraindication to it.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Agonistas de Dopamina / Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT) / Cabergolina Tipo de estudio: Observational_studies / Prognostic_studies / Systematic_reviews Límite: Humans Idioma: En Revista: J Endocrinol Invest Año: 2018 Tipo del documento: Article País de afiliación: India Pais de publicación: Italia
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Agonistas de Dopamina / Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT) / Cabergolina Tipo de estudio: Observational_studies / Prognostic_studies / Systematic_reviews Límite: Humans Idioma: En Revista: J Endocrinol Invest Año: 2018 Tipo del documento: Article País de afiliación: India Pais de publicación: Italia