Long-term results of cabergoline therapy for macroprolactinomas and analyses of factors associated with remission after withdrawal

Abstract

Objective

Withdrawal of cabergoline is generally challenging, especially in patients with large or invasive macroprolactinomas. Therefore, we aimed to assess long-term results of cabergoline therapy for macroprolactinomas and remission achievement results after withdrawal in patients with macroprolactinomas. We also investigated clinical characteristics and factors related to remission after withdrawal.

Methods

This was an institutional review board approved retrospective analysis. We studied 46 macroprolactinoma patients who had taken cabergoline during the period from 2003 through 2013. Administration of cabergoline was maintained for 5 years before withdrawal in all cases.

Results

Median follow-up after the initiation of cabergoline therapy was 54.3 (range 5.3 to 137.2) months. Recurrences of hyperprolactinemia were observed in 3 of 11 (27%) post-withdrawal patients at a median time of 3.0 (range; 2.9-11.2) months, indicating that a high percentage (73%) maintained remission for at least 12 months after cabergoline cessation. Factors significantly associated with remission were analyzed in 21 patients receiving long-term cabergoline administration. On multivariate analysis, absence of cavernous sinus invasion on pretreatment MRI (≥3/4 tumor encasement of the intracavernous internal carotid artery) (HR; 21.94, 95% CI; 2.06-1071.0, p=0.006), initial PRL <132.7 ng/ml (HR; 8.28, 95% CI; 1.24-199.6, p=0.03), and nadir PRL <1.9 ng/ml during cabergoline therapy (HR; 5.14, 95% CI; 1.10-39.02, p=0.04) showed statistically significant correlations with remission after withdrawal.

Conclusions

Cabergoline therapy can achieve a high percentage (73% in this series) of remission maintenance for at least 12 months after cessation of a 5-year course of therapy, even in patients with macroprolactinomas. Absence of cavernous sinus invasion, serum PRL level lower than 132.7 ng/ml before cabergoline therapy, or nadir serum PRL below 1.9 ng/ml were related to more frequent remission after withdrawal of cabergoline in patients receiving this medication for 5 years.

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