Thursday, August 12, 2010

Cabergoline monotherapy in the long-term treatment of Cushing's disease

Ariane Godbout, Marcos Paulo Manavela, Karina Danilowicz, Hugues Beauregard, Oscar Domingo Bruno and André Lacroix

A Godbout, Endocrinology, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada
M Manavela, Endocrinology, Hospital de Clínicas, Ciudad Autónoma de Buenos Aires, 1120, Argentina
K Danilowicz, Endocrinology, Hospital de Clinicas, Ciudad de Buenos Aires, 1120, Argentina
H Beauregard, Endocrinology, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada
O Bruno, Endocrinology, Hospital de Clínicas, Ciudad Autónoma de Buenos Aires, 1120, Argentina
A Lacroix, Endocrinology, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada

Correspondence: Ariane Godbout, Email: arianegodbout@hotmail.com

Background: Cabergoline is a long-acting dopamine receptor agonist used to treat prolactinomas. Identification of D2-receptors in corticotroph tumors led to clinical trials of cabergoline therapy in limited cases of Nelson’s syndrome, ectopic ACTH-secreting tumors and recently Cushing’s disease (CD).

Objective: Evaluate the long-term efficacy of cabergoline monotherapy in patients with CD.

Methods: Retrospective analysis of non-randomized clinical therapy with cabergoline in 30 patients with CD treated in academic centers of Buenos Aires and Montreal. Cabergoline was initiated at 0.5-1.0 mg/wk and adjusted up to a maximal dose of 6 mg/wk based on urinary free cortisol (UFC) levels. Complete response to cabergoline was defined as a sustained normalization of UFC with at least two normal values measured at 1 to 3 months interval; partial response was defined as a decrease of UFC to <125% of the upper limit of normal, and treatment failure as UFC ?125% of it.

Results: Within 3-6 months, complete response was achieved in 11 patients (36.6%) and partial response in 4 (13.3%). After longer term therapy, 9 patients (30%) remain with a complete response after a mean of 37 months (range from 12-60 months) with a mean dose of 2.1 mg/wk of cabergoline. Two patients escaped after 2 and 5 years of complete response, but one transiently renormalized UFC after an increase in cabergoline dosage. No long-term response was maintained in 4 initial partial responders.

Conclusions: Cabergoline monotherapy can provide an effective long-term medical therapy for selected patients with CD, but requires close follow-up for dose adjustments.

 

From http://www.eje.org/cgi/content/abstract/EJE-10-0382v1