Mortality in patients with dopamine agonist-treated hyperprolactinemia: a large matched-cohort study

Area of Science:

• Endocrinology
• Clinical Medicine
• Epidemiology

Background:

• Hyperprolactinemia, a condition of elevated prolactin levels, affects a significant population.
• Limited data exists on the long-term mortality risks associated with hyperprolactinemia, particularly in patients treated with dopamine agonists (DAs).
• Understanding mortality patterns is crucial for comprehensive patient management.

Purpose of the Study:

• To evaluate the all-cause mortality risk in a large cohort of patients with hyperprolactinemia treated with dopamine agonists.
• To identify factors influencing mortality, including disease severity, treatment response, and comorbidities.

Main Methods:

• A nationwide retrospective cohort study (2000-2023) utilized the Clalit Health Services database.
• Patients with hyperprolactinemia treated with DAs were matched 1:5 with controls based on age, sex, BMI, and socioeconomic status.
• All-cause mortality was the primary outcome, with secondary analyses on prolactin normalization and baseline prolactin levels.

Main Results:

• No significant difference in all-cause mortality was observed between hyperprolactinemia patients (7.3%) and matched controls (7.5%) over a median follow-up of 17 years.
• Achieving prolactin normalization within one year was associated with reduced mortality (HR=0.730).
• Patients with baseline prolactin <5x ULN had lower mortality than those with ≥5x ULN. Mortality was higher in men than women with hyperprolactinemia.

Conclusions:

• Dopamine agonist-treated hyperprolactinemia does not confer an increased risk of all-cause mortality compared to matched controls.
• Mortality is significantly influenced by age, sex, BMI, and the presence of comorbidities.
• Early prolactin normalization is associated with improved survival outcomes in hyperprolactinemia patients.