Cabergoline for Cushing’s disease: a large retrospective multicenter study

Author:

Ferriere A1,Cortet C2,Chanson P3,Delemer B4,Caron P5,Chabre O6,Reznik Y7,Bertherat J8,Rohmer V9,Briet C9,Raingeard I10,Castinetti F11,Beckers A12,Vroonen L12,Maiter D13,Cephise-Velayoudom F L14,Nunes M L1,Haissaguerre M1,Tabarin A1

Affiliation:

1. 1CHU BordeauxHôpital Haut-Lévêque, Service d’Endocrinologie, Diabétologie et Nutrition, Pessac, France or INSERM U862, Neurocentre Magendie, Université Bordeaux, Bordeaux Cedex, France

2. 2CHRU LilleService d’Endocrinologie, Diabétologie et Métabolisme, Lille Cedex, France

3. 3Assistance Publique-Hôpitaux de ParisHôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, France

4. 4CHU ReimsHôpital Robert Debré, Service d’Endocrinologie, Diabétologie et Nutrition, Reims, France

5. 5CHU ToulouseHôpital Larrey, Service d’Endocrinologie, Maladies Métaboliques et Nutrition, Toulouse cedex 9, France

6. 6CHU Grenoble AlpesService d’Endocrinologie-Diabétologie, Boulevard de la Chantourne, La Tronche, France

7. 7CHU CaenService d’Endocrinologie-Diabétologie, CAEN cedex 9, France

8. 8Assistance Publique-Hôpitaux de ParisHôpitaux universitaires Paris-Centre, Hôpital Cochin, Service d’Endocrinologie et Maladies Métaboliques, Paris, France

9. 9CHU AngersDépartement d’Endocrinologie-Diabétologie-Nutrition, Angers Cedex 9, France

10. 10CHU MontpellierService d’Endocrinologie, Diabète, Maladies métaboliques, Montpellier, France

11. 11Assistance Publique-Hôpitaux de MarseilleHôpital de la Conception, Service d’Endocrinologie, Diabètes et Maladies Métaboliques, Marseille, France

12. 12CHU LiègeService d’Endocrinologie, Domaine Universitaire du Sart Tilman, Liège, Belgique

13. 13Clinique Universitaire Saint LucService d’Endocrinologie et de Nutrition, Bruxelles, Belgique

14. 14CHU Pointe à PitreService d’Endocrinologie, Pointe à Pitre, France

Abstract

Objective The efficacy of cabergoline in Cushing’s disease (CD) is controversial. The aim of this study was to assess the efficacy and tolerability of cabergoline in a large contemporary cohort of patients with CD. Design We conducted a retrospective multicenter study from thirteen French and Belgian university hospitals. Methods Sixty-two patients with CD received cabergoline monotherapy or add-on therapy. Symptom score, biological markers of hypercortisolism and adverse effects were recorded. Results Twenty-one (40%) of 53 patients who received cabergoline monotherapy had normal urinary free cortisol (UFC) values within 12 months (complete responders), and five of these patients developed corticotropic insufficiency. The fall in UFC was associated with significant reductions in midnight cortisol and plasma ACTH, and with clinical improvement. Compared to other patients, complete responders had similar median baseline UFC (2.0 vs 2.5xULN) and plasma prolactin concentrations but received lower doses of cabergoline (1.5 vs 3.5 mg/week, P < 0.05). During long-term treatment (>12 months), cabergoline was withdrawn in 28% of complete responders because of treatment escape or intolerance. Overall, sustained control of hypercortisolism was obtained in 23% of patients for 32.5 months (19–105). Nine patients on steroidogenesis inhibitors received cabergoline add-on therapy for 19 months (1–240). Hypercortisolism was controlled in 56% of these patients during the first year of treatment with cabergoline at 1.0 mg/week (0.5–3.5). Conclusions About 20–25% of CD patients are good responders to cabergoline therapy allowing long-term control of hypercortisolism at relatively low dosages and with acceptable tolerability. No single parameter, including the baseline UFC and prolactin levels, predicted the response to cabergoline.

Publisher

Bioscientifica

Subject

Endocrinology,General Medicine,Endocrinology, Diabetes and Metabolism

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