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Second attempt to withdraw cabergoline in prolactinomas: a pilot study.

Ratchaneewan Kwancharoen, Renata Simona Auriemma, Gayane Yenokyan

|October 1, 2013

Summary

Discontinuing cabergoline (CAB) therapy after a previous unsuccessful attempt may succeed in some hyperprolactinemia patients. Close prolactin monitoring is crucial, as most recurrences happen within the first year.

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Area of Science:

Endocrinology
Pharmacology

Background:

Cabergoline (CAB) is a dopamine agonist used to treat hyperprolactinemia.
Current guidelines suggest discontinuing CAB after 2 years for eligible patients, but recurrence rates vary (26-69%).
The success of a second CAB withdrawal attempt after an initial failure is not well-established.

Purpose of the Study:

To evaluate the efficacy and safety of a second attempt at cabergoline withdrawal in patients with recurrent hyperprolactinemia.
To assess the recurrence rates and time to recurrence following a second withdrawal of cabergoline therapy.

Main Methods:

A pilot prospective, two-center study was conducted.
Inclusion criteria included hyperprolactinemia recurrence after a first withdrawal, at least 2 years of additional CAB therapy, normal prolactin levels, and a CAB dose ≤ 1 mg/week.

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Prolactin levels were monitored post-discontinuation, with a median follow-up of 42 months for patients in remission.

Main Results:

17 patients were recruited, with a mean age of 41.0 years; 65% were female.
The average weekly CAB dose at second withdrawal was 0.38 mg.
Eleven of 17 patients (64.7%) experienced recurrence, with a median time to recurrence of 6 months. The incidence of recurrence was 44 events per 100 person-years.

Conclusions:

A second attempt at cabergoline withdrawal, following 2 additional years of therapy, can be successful in some hyperprolactinemic patients.
Close monitoring of prolactin levels is recommended during and after a second withdrawal attempt.
No predictors of recurrence were identified, and most recurrences occurred within 12 months post-withdrawal.