A randomized cross-over study comparing cabergoline and quinagolide in the treatment of hyperprolactinemic patients

Abstract

Quinagolide (QUI) and cabergoline (CAB) are dopamine agonists recently introduced for the treatment of hyperprolactinemia. In the present study, these drugs have been compared in terms of effectiveness and tolerability. Twenty patients (18 females and 2 males) with hyperprolactinemia (8 with microprolactinomas, 6 with idiopathic hyperprolactinemia and 6 with empty sella turcica syndrome) were treated with oral QUI (75 microg once daily) and CAB (0,5 mg twice weekly), in a randomized cross-over trial with placebo between both drugs. Each drug was administered for 12 weeks, separated by other 12 weeks with placebo. PRL levels decreased with both drugs at 2 or 4 weeks of starting the treatment, without differences between both drugs at weeks 4, 8 and 12. At week 12, normal PRL levels (<20 ng/ml) were attained in 90% patients with CAB and only in 75% patients with QUI (p<0.05). After discontinuation of treatment, significant increase in serum PRL was higher after QUI withdrawal than after CAB. Clinical efficacy of both treatments was similar in terms of improvement amenorrhea, oligomenorrhea, galactorrhea, and impotence. All patients completed both cycles of treatment, and the most frequent side-effects were nausea, headache and dizziness, without significant differences between CAB (30%) and QUI (55%). Our study indicates that, at the doses employed here, CAB showed a high percentage of patients with normal PRL at the end of treatment and long-lasting efficacy in the levels of PRL. Clinical response and side-effects were similar in both drugs.

Advances in the Treatment of Prolactinomas

“…In a randomized, cross-over study, 20 patients with hyperprolactinemia received once-daily quinagolide or twiceweekly cabergoline for 12 wk, with the two treatment phases separated by a washout period of 12 wk with placebo (232). A higher percentage of patients achieved normal PRL levels with cabergoline compared with quinagolide (90 vs. 75%; P Ͻ 0.05), but clinical efficacy, such as amenorrhea, oligomenorrhea, galactorrhea, and impotence, was similar as was the occurrence of side effects (232). In another study, Di Sarno et al (224) compared the outcome of quinagolide and cabergoline in a sequential treatment administered to 39 patients.…”

Quinagolide – a valuable treatment option for hyperprolactinaemia

“…In a randomized, cross-over study, 20 patients with hyperprolactinaemia received once-daily quinagolide or twice-weekly cabergoline for 12 weeks, with the two treatment phases separated by a wash-out period of 12 weeks with placebo (51). In this study, a higher percentage of patients with hyperprolactinaemia achieved normal prolactin levels with cabergoline compared with quinagolide (90 vs 75%; P , 0.05).…”

“…In this study, a higher percentage of patients with hyperprolactinaemia achieved normal prolactin levels with cabergoline compared with quinagolide (90 vs 75%; P , 0.05). However, clinical efficacy was similar between treatments in terms of improvement of symptoms, such as amenorrhoea, oligomenorrhoea, galactorrhoea and impotence, and there was no difference in the occurrence of side-effects (51).…”

Arbeitsweise einer interdisziplin�ren neurochirurgisch-endokrinologischen Sprechstunde f�r Hypophysentumoren am Universit�tsklinikum Leipzig und Ergebnisse der Behandlung von hormonaktiven Hypophysenadenomen

“…Der Tumorreduktionseffekt setzt sehr schnell nach Beginn der Therapie ein und kann über Jahre anhalten. Die Dopaminagonisten der zweiten Generation wie Cabergolin zeichnen sich nicht nur durch eine hohe Effektivität zur Erreichung einer Normoprolaktinämie (83% [31] bis 90% [32] im Vergleich zu 59% bei Bromocriptin) aus, sondern auch durch weniger häu-fige, weniger schwere und kürzere Nebenwirkungen als unter Bromocriptin [31,32]. Die höhere Effektivität ist in der hohen Affinität zum D 2 -Rezeptor und der langen Verweildauer im Gewebe begründet, die geringere Nebenwirkungsrate erklärt sich durch eine geringere Affinität zum D 1 -Rezeptor.…”