SFEBES2022 Poster Presentations Neuroendocrinology and Pituitary (72 abstracts)
Cabergoline in acromegaly – a multicenter, retrospective, cohort study of non-irradiated patients using current criteria for disease control
Sandrine A Urwyler 1,2,3 , Irene Samperi 1,2,3 , Kirstie Lithgow 1,2,3 , Akash Mavilakandy 4 , Mike Matheou 5 , John Ayuk 1,2,3 , Karin Bradley 6 , Aparna Pal 5 , Narendra L Reddy 4 & Niki Karavitaki 1,2,3
1Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; 2Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom; 3Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; 4Department of Diabetes and Endocrinology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, United Kingdom; 5Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; 6Department of Endocrinology, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
Background: Cabergoline monotherapy or in combination with somatostatin analogue (SSA) has been reported in few studies with IGF-1-normalization-rates 0%-100%(monotherapy) and 42%-60%(combination therapy). However, in these studies, inclusion of irradiated patients is a potential confounder and currently proposed disease control criteria (normal IGF-1, GH<1 mg/l) have not been applied.
Aim: Investigate the efficacy of cabergoline monotherapy or as add-on to ongoing SSA-therapy in achieving biochemical control in non-irradiated patients with acromegaly.
Patients and methods: Multicenter, retrospective cohort study involving non-irradiated patients offered cabergoline monotherapy or add-on to SSA for uncontrolled acromegaly from four UK Pituitary centers (Birmingham, Bristol, Leicester and Oxford). Clinical/laboratory data were analyzed.
Results: Patients on cabergoline monotherapy (n=69): Median IGF-1pre-cabergoline 2.13xupper limit of normal (ULN) (1.02-8.54) and median duration of cabergoline treatment 23 months (3-252). Normal IGF-1 was achieved in 31.9% of patients. Latest median weekly cabergoline dose was 2.5 mg (0.25-4) (responders), 3 mg (0.25-7) (non-responders), (P=0.39). On univariate regression analysis, IGF-1-normalisation was related with prolactin co-secreting adenoma (B 1.50, P=0.019) and lower IGF-1pre-cabergoline (B-0.70, P=0.015). On ROC analysis, IGF-1<1.97ULN had sensitivity 71% and specificity 65% in predicting IGF-1 normalisation (AUC 0.745). GH<1 mg/l was found in 25.8% and normal IGF-1+GH<1 mg/l in 12.9% of patients. Patients on combination therapy (n=26): Median duration of SSA-treatment before cabergoline 18 months (2-118), IGF-1pre-cabergoline1.70xULN (1.03-2.92), median duration of SSA+cabergoline 36 months (4-139). Normal IGF-1 was achieved in 23.1% of the patients. Latest median weekly cabergoline dose was 1.25 mg (0.5-3) (responders), 3 mg (0.5-4.5) (non-responders), (P=0.134). GH<1 mg/l was found in 39.1% and normal IGF-1+GH<1 mg/l in 17.4% of patients.
Conclusions: IGF-1 levels normalized in 32% (monotherapy) and in 23% (combination-therapy) of patients. For monotherapy lower IGF-1pre-cabergoline and prolactin co-secreting adenoma were associated with IGF-1 normalization. The response rate to combination-therapy was lower compared to previous reports, possibly due to the exclusion of irradiated patients.
Volume 86
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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