Effect of cabergoline monotherapy in Cushing’s disease: an individual participant data meta-analysis

• Published in: Journal of endocrinological investigation Vol. 41; no. 12; pp. 1445 - 1455
• Main Authors: Palui, R., Sahoo, J., Kamalanathan, S., Kar, S. S., Selvarajan, S., Durgia, H.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2018; Springer Nature B.V
• Subjects: Adenoma; Adrenocorticotropic hormone; Cabergoline - therapeutic use; Cushing's disease; Data processing; Dopamine Agonists - therapeutic use; Endocrinology; Humans; Hydrocortisone; Medicine; Medicine & Public Health; Meta-analysis; Metabolic Diseases; Nervous system diseases; Original Article; Patients; Pituitary; Pituitary ACTH Hypersecretion - drug therapy; Remission; Surgery; Treatment Outcome; Remission; Urinary free cortisol; Cushing’s disease; Cabergoline; Dopamine agonist
• ISSN: 1720-8386; 0391-4097; 1720-8386
• DOI: 10.1007/s40618-018-0936-7

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 CD with cabergoline monotherapy was 39.4% (95% confidence interval 0.31–0.49; P  = 0.026). 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.