Optimal timing of dopamine agonist withdrawal in patients with hyperprolactinemia: a systematic review and meta-analysis
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META-ANALYSIS
Optimal timing of dopamine agonist withdrawal in patients with hyperprolactinemia: a systematic review and meta-analysis Miao Yun Xia1 Xiao Hui Lou2 Shao Jian Lin1 Zhe Bao Wu1 ●
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Received: 7 May 2017 / Accepted: 27 September 2017 / Published online: 17 October 2017 © Springer Science+Business Media, LLC 2017
Abstract Purpose Dopamine agonists (DAs) are recommended as first-line treatment for patients with hyperprolactinemia. Generally, it is accepted that patients with hyperprolactinemia do not need lifelong medication, but the optimal timing for DA withdrawal has not been determined. The aim of this systematic review and meta-analysis is to assess the impact of DA withdrawal on the clinical outcomes of patients with hyperprolactinemia, and to explore possible factors affecting successful DA withdrawal. Methods The databases of PubMed, Cochrane and EMBASE were searched up to May 2016. Results The proportion of patients with persisting normoprolactinemia after DA withdrawal reached 36.6% in a random effects model (95% CI, 29.4–44.2%; I-squared: 82.5%). Data of stratified analysis showed that the success rate of drug withdrawal was high in patients using cabergoline (CAB) as the only treatment (41.2%; 95% CI 32.3–50.4%) and those using CAB over 24 months (48.7%; 95% CI 38.9–58.5%), especially in patients with idiopathic hyperprolactinemia (73.2%; 95% CI 55.6–87.7%). In addition, patients who received a low maintenance dose of CAB, and had a significant reduction in tumor size (over 50%) before withdrawal, were more likely to achieve success (51.5 and 49.4%, respectively).
Miao Yun Xia and Xiao Hui Lou contributed equally to this work. * Zhe Bao Wu [email protected] 1
Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China
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Department of Neurosurgery, Third Affiliated Hospital of Wenzhou Medical University, 325200 Wenzhou, China
Conclusion The success rate of DA withdrawal has increased in recent years. Further, the success rate of CAB withdrawal was higher than that of bromocriptine, especially in patients with a duration of treatment longer than 24 months. Conclusively, the probability of success was higher in patients who received low-dose CAB maintenance treatment and those who achieved a significant reduction in tumor size before withdrawal. Keywords Dopamine agonists Withdrawal Hyperprolactinemia Prolactinoma Cabergoline Bromocriptine ●
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Introduction Dopamine agonists (DAs) are the first-line treatment for hyperprolactinemia, they can effectively reduce prolactin (PRL) level and tumor size [1–5]. Bromocriptine (BRC) and cabergoline (CAB) are the most commonly used DAs. However, after treatment, sudden stop of DA administration may run the risk of tumor re-growth and recurrence [6–8]. Therefore, the question of how to reasonably reduce the dose of DAs and achieve a complete withdrawal is a critical clinical issue of great significance. The 2005 edition Guidelines of the Pituitary Society for the diagnosis and management
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