Place of cabergoline in acromegaly: a meta-analysis.

Abstract

CONTEXT:

Cabergoline is widely considered to be poorly effective in acromegaly.

OBJECTIVE:

The aim of this study was to obtain a more accurate picture of the efficacy of cabergoline in acromegaly, both alone and in combination with somatostatin analogs.

DESIGN:

We systematically reviewed all trials of cabergoline therapy for acromegaly published up to 2009 in four databases (PubMed, Pascal, Embase, and Google Scholar). We identified 15 studies (11 prospective) with a total of 237 patients; none were randomized or placebo-controlled. A meta-analysis was conducted on individual data (n = 227).

RESULTS:

Cabergoline was used alone in nine studies. Fifty-one (34%) of the 149 patients achieved normal IGF-I levels. In multivariate analysis, the decline in IGF-I was related to the baseline IGF-I concentration (β = 1.16; P <0.001), treatment duration (β = 0.28; P < 0.001), and baseline prolactin concentration (β = -0.18; P = 0.01), and with a trend toward a relation with the cabergoline dose (β = 0.38; P =0.07). In five studies, cabergoline was added to ongoing somatostatin analog treatment that had failed to normalize IGF-I. Forty patients (52%) achieved normal IGF-I levels. The change in IGF-I was significantly related to the baseline IGF-I level (β = 0.74; P < 0.001) but not to the dose of cabergoline, the duration of treatment, or the baseline prolactin concentration.

CONCLUSION:

This meta-analysis suggests that cabergoline single-agent therapy normalizes IGF-I levels in one third of patients with acromegaly. When a somatostatin analog fails to control acromegaly, cabergoline adjunction normalizes IGF-I in about 50% of cases. This effect may occur even in patients with normoprolactinemia.

• Authors: Laure Sandret, Patrick Maison, Philippe Chanson
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 96 Issue 5 Pg. 1327-35 (May 2011) ISSN: 1945-7197 [Electronic] United States
• PMID: 21325455 (Publication Type: Journal Article, Meta-Analysis, Review)

Chemical References

• Antineoplastic Agents
• Ergolines
• Hormone Antagonists
• Human Growth Hormone
• Somatostatin
• Insulin-Like Growth Factor I
• Cabergoline

Topics

• Acromegaly (drug therapy, pathology)
• Adult
• Antineoplastic Agents (adverse effects, therapeutic use)
• Cabergoline
• Data Interpretation, Statistical
• Ergolines (adverse effects, therapeutic use)
• Female
• Growth Hormone-Secreting Pituitary Adenoma (drug therapy, pathology)
• Hormone Antagonists (therapeutic use)
• Human Growth Hormone (blood)
• Humans
• Hyperprolactinemia (drug therapy, etiology)
• Insulin-Like Growth Factor I (metabolism)
• Male
• Middle Aged
• Somatostatin (analogs & derivatives, therapeutic use)
• Treatment Outcome