Cabergoline Withdrawal Before and After Menopause: Outcomes in Microprolactinomas

Abstract

Natural course of prolactinomas after menopause is not fully elucidated. The aim of this study was to compare recurrence rate after cabergoline withdrawal in premenopausal vs. postmenopausal women with microprolactinoma. Sixty-two women with microprolactinoma treated with cabergoline for at least 1 year and followed for 2 years after drug withdrawal were retrospectively selected. Patients were divided into two groups: 48 patients stopped cabergoline before menopause (BPRE^group), while 14 after menopause (BPOST^group). Recurrence was defined by prolactin levels above normal, confirmed on two occasions. Overall, 39/62 women relapsed. Patients who relapsed apparently had higher prolactin before withdrawal (median 216.2, range 21.2-464.3 mIU/L) compared with those in long-term remission (94.3, 29.7-402.8 mIU/L; p < 0.05), and the risk of recurrence seemed lower in POST women (4/14, 29%) than in PRE ones (35/48, 73%, p < 0.005, OR 0.149, 95% CI 0.040-0.558). However, none of the factors (prolactin before withdrawal, menopausal status, treatment duration, complete adenoma regression) showed a correlation with recurrence risk in multivariate analysis. The best strategy able to optimize CBG treatment and withdrawal's outcomes is still to be defined in microprolactinomas. Postmenopausal status cannot reliably predict long-term remission, and follow-up is needed also in women of this age.

Withdrawal of dopamine agonist treatment in patients with hyperprolactinaemia: A systematic review and meta‐analysis

“…The current review included newer studies published after 2010 which selected their patients according to the Pituitary Society Guidelines 25,40,47,53,56 or similar inclusion criteria. 19,21,23,24,34,45 following cessation of either cabergoline or bromocriptine. 17 The above-cited systematic reviews chose to report pooled estimates of effects despite very high heterogeneity which all were ≥81%.…”

“…As illustrated in the PRISMA flow diagram (shown in Figure 1) 33 publications [19][20][21][22][23][24][25][26] reporting withdrawal of dopamine agonists in patients with hyperprolactinaemia in 32 trials [19][20][21][22][23][24][25][26][33][34][35][36][37][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] were identified. The number of patients included from each trial ranged from 2 to 221 and a total of 1563 patients were included in the final analysis.…”

“…Ten trials reported on withdrawal of bromocriptine, 37,41,44,[48][49][50]52,54,55,57 12 trials on withdrawal of cabergoline, 21,23,24,26,36,39,42,46,47,51,53,56 and 10 trials on withdrawal of both bromocriptine and cabergoline. 19,20,22,25,[33][34][35]40,43,45 Ten trials included patients with microprolactinomas, 23,33,35,37,41,44,45,[49][50][51] three trials included patients with macroprolactinomas, 21,54,55 16 trials included patients with both micro-and macroprolactinomas, 19,20,22,[24][25]…”

“…36,52 Twenty five studies included both genders, 19-21,24-26,33-37,39-47,52-56 the remaining seven studies only included women. 22,23,[48][49][50][51]57 Participants were enroled consecutively in six studies, 21,24,34,46,47,54 not enroled consecutively in 10 studies, 22,23,39,40,[43][44][45]50,51,55 and in 16 studies the enrolment was unclear. 19,20,25,26,33,[35][36][37]41,42,48,49,52,53,56,57 Seven studies were conducted prospectively, 45,47,48,50,51,54,56 18 retrospectively, [19][20]…”

“…Furthermore, new studies have been conducted since the last systematic review was published. [19][20][21][22][23][24][25][26] The aim of the present systematic review was therefore to estimate the pooled proportion of patients with persistent normoprolactinaemia following the withdrawal of dopamine agonists and to identify predictors of successful withdrawal from dopamine agonist treatment in patients with hyperprolactinaemia.…”