Treatment escape reduces the effectiveness of cabergoline during long-term treatment of acromegaly in monotherapy or in association with first-generation somatostatin receptor ligands

Abstract

Background

Few studies evaluated the use of cabergoline (CAB) for acromegaly treatment in monotherapy or in combination with first-generation somatostatin receptor ligands (SRLs).

Aim

Evaluate the efficacy, predictors of response and safety of CAB treatment in acromegaly both in monotherapy and in combination with SRLs.

Methods

We retrospectively collected demographic, biochemical, tumor and treatment data. Short-term disease control was defined as random GH level <1.0 μg/L and normal age-matched IGF-I level after 3-6 months of treatment with the higher dose used. Long-term disease control was defined as maintenance of normal GH and IGF-I levels at the last visit (at least nine months of treatment).

Results

82 patients were studied. The median total time of treatment in monotherapy or in combination with SRLs was 14 months (3 – 124) and 34 months (3 – 88), respectively. Short-term disease control was observed in six (21%) patients in the monotherapy group and in 20 (32%) in the combination group. Treatment escape was observed in one patient after 16 months of CAB monotherapy and in six (30%) patients with combination therapy (after a median of 38 months), resulting in long-term disease control of 18% and 23%, respectively. Hyperprolactinemia was a predictor of response to monotherapy and pre-treatment GH level to combination treatment.

Conclusion

We presented the results of the largest single-center study with CAB in monotherapy and in combination with SRL. The efficacy of CAB in acromegaly seems to be lower than that of other drugs, and treatment escape may occur after a long-term follow-up.

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