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Current drug withdrawal strategy in prolactinoma patients treated with cabergoline: a systematic review and meta-analysis

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Abstract

Background

Cabergoline is a recommended first-line dopamine agonist for prolactinoma treatment, which is withdrawable for some cases. However, the optimal withdrawal strategy and the accurate recurrence rate associated with cabergoline withdrawal remains uncertain.

Objective

To assess the current recurrence rate of hyperprolactinemia and possible favorable factors associated with cabergoline withdrawal in prolactinoma patients.

Method

The databases of PubMed, EMBASE, and Web of Science were searched up to May 2014 to identify studies containing data of recurrent hyperprolactinemia in prolactinoma patients after cabergoline withdrawal. Meta-analysis, including sensitivity analysis, meta-regression analysis, and subgroup analysis were performed.

Results

When the patients who received cabergoline withdrawal were pooled, it was found that the hyperprolactinemia recurrence rate was 65 % by a random effects meta-analysis [95 % confidence interval 55–74 %]. In a random effects meta-regression adjusting for optimal withdrawal strategies, CAB dose reduced to the lowest level before withdrawal was associated with treatment success (p = 0.006), whereas CAB treatment longer than 2 years showed no trend of effect (p = 0.587). Patients who received the lowest CAB dose and presented a significant reduction in tumor size before withdrawal were more likely to achieve the best success (p < 0.001).

Conclusions

Our meta-analysis shows that hyperprolactinemia recurs after cabergoline withdrawal in a majority of patients. The probability of success favors patients who have achieved normoprolactinemia and considerable reduction in tumor size by low dose of cabergoline treatment. In addition, our study further suggests that a beneficial strategy is associated with tapering CAB dose before withdrawal but not with CAB treatment duration longer than 2 years.

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Acknowledgments

The authors sincerely thank Prof. Rufu Xu (Evidence Based Medicine and Epidemiology Center, Third Military University, Chongqing, China) for helpful comments on the statistical methods.

Conflict of interest

No conflict of interest exits in the submission of this manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, XinQiao Hospital, Third Military Medical University, 2-V Xinqiao Street, Chongqing, 400037, People’s Republic of China

    Jintao Hu, Xin Zheng & Hui Yang

  2. Department of Biology and Biochemistry, University of Houston, Houston, TX, USA

    Weihua Zhang

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  1. Jintao Hu
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  2. Xin Zheng
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  3. Weihua Zhang
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  4. Hui Yang
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Correspondence to Hui Yang.

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Hu, J., Zheng, X., Zhang, W. et al. Current drug withdrawal strategy in prolactinoma patients treated with cabergoline: a systematic review and meta-analysis. Pituitary 18, 745–751 (2015). https://doi.org/10.1007/s11102-014-0617-2

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