Efficacy of cabergoline in non-irradiated patients with acromegaly: a multi-centre cohort study.
Urwyler, Sandrine A Samperi, Irene Lithgow, Kirstie Mavilakandy, Akash Matheou, Mike Bradley, Karin Pal, Aparna Reddy, Narendra L Ay, John Karavitaki, Niki
Urwyler, Sandrine A
Samperi, Irene
Lithgow, Kirstie
Mavilakandy, Akash
Matheou, Mike
Bradley, Karin
Pal, Aparna
Reddy, Narendra L
Ay, John
Karavitaki, Niki
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2024-01-17
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Abstract
Objective: Elucidate the efficacy (as per current biochemical criteria) of cabergoline monotherapy or as addition to long-acting somatostatin receptor ligand (SRL) in patients with acromegaly and no previous pituitary radiotherapy.
Design: Multi-centre, retrospective, cohort study (four UK Pituitary centres: Birmingham, Bristol, Leicester, Oxford).
Methods: Clinical, laboratory, imaging data were analysed.
Results: Sixty-nine patients on cabergoline monotherapy were included [median IGF-1 xUpper Limit of Normal (ULN) pre-cabergoline 2.13 (1.02-8.54), median treatment duration 23 months, median latest weekly dose 3 mg]. 31.9% achieved normal IGF-1 (25% GH-secreting, 60% GH+prolactin co-secreting tumours); median weekly cabergoline dose was similar between responders and non-responders. IGF-1 normalisation was related with GH+prolactin co-secreting adenoma (B 1.50, p=0.02) and lower pre-cabergoline IGF-1 xULN levels (B -0.70, p=0.02). Both normal IGF-1 and GH<1 mcg/L were detected in 12.9% of cases and tumour shrinkage in 29.4% of GH-secreting adenomas.Twenty-six patients on SRL+cabergoline were included [median IGF-1 xULN pre-cabergoline 1.7 (1.03-2.92), median treatment duration 36 months, median latest weekly dose 2.5 mg]. 23.1% achieved normal IGF-1 (15.8% GH-secreting, 33.3% GH+prolactin co-secreting tumours). Normal IGF-1 and GH<1 mcg/L were detected in 17.4%.
Conclusions: In non-irradiated patients, cabergoline normalises IGF-1 in around one-third and achieves both IGF-1 and GH targets in approximately one out of ten cases. SRL+cabergoline is less efficient than previously reported possibly due to differences in studies methodology and impact of confounding factors.
Citation
Urwyler SA, Samperi I, Lithgow K, Mavilakandy A, Matheou M, Bradley K, Pal A, Reddy NL, Ay J, Karavitaki N. Efficacy of cabergoline in non-irradiated patients with acromegaly: a multi-centre cohort study. Eur J Endocrinol. 2024 Jan 17:lvae003. doi: 10.1093/ejendo/lvae003.
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