Real-world value of cabergoline in the treatment of acromegaly

IF 6.1 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Best practice & research. Clinical endocrinology & metabolism Pub Date : 2024-07-01 DOI:10.1016/j.beem.2024.101887
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Abstract

Cabergoline is an ergot derivative long-acting dopamine receptor 2 (DR2) selective agonist administered orally and widely used for the treatment of prolactin-secreting adenomas and Parkinson’s disease. DR2 is expressed in most somatotroph adenomas. In acromegaly, cabergoline is used off-label and its role is limited by the relatively modest efficacy for achieving hormonal remission and thus, it is largely indicated in patients with mild elevation of GH/IGF-I postoperatively. It can be given as monotherapy, usually at a higher weekly dose than usually required to treat prolactinomas, but also as an add-on treatment in patients partially responding to the somatostatin receptor ligands octreotide or lanreotide. IGF-1 normalization with cabergoline can be achieved in about a third of the patients. Low baseline IGF-1 level (below 1.5 x ULN) before cabergoline initiation is a good predictor for remission. Combination treatment with the GH receptor antagonist pegvisomant can also be beneficial. The inexpensive, well-tolerated and convenient oral administration of cabergoline makes it an attractive medical therapy for active acromegaly.

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卡麦角林治疗肢端肥大症的实际价值
卡麦角林是一种麦角衍生物,是一种长效多巴胺受体 2(DR2)选择性激动剂,口服给药,广泛用于治疗分泌催乳素的腺瘤和帕金森病。在肢端肥大症中,卡麦角林属于标签外用药,其作用受到限制,因为它在实现激素缓解方面的疗效相对较弱,因此主要适用于术后 GH/IGF-I 轻度升高的患者。它可以作为单药治疗,通常每周剂量高于治疗催乳素瘤所需的剂量,也可以作为对体泌素受体配体奥曲肽或兰瑞肽有部分反应的患者的附加治疗。约有三分之一的患者可以通过卡贝戈林实现 IGF-1 正常化。开始使用卡麦角林前,低基线 IGF-1 水平(低于 1.5 x ULN)是病情缓解的良好预测指标。与 GH 受体拮抗剂 pegvisomant 的联合治疗也有益处。卡麦角林价格低廉、耐受性好且口服方便,是治疗活动性肢端肥大症的一种极具吸引力的药物疗法。
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来源期刊
CiteScore
11.90
自引率
0.00%
发文量
77
审稿时长
6-12 weeks
期刊介绍: Best Practice & Research Clinical Endocrinology & Metabolism is a serial publication that integrates the latest original research findings into evidence-based review articles. These articles aim to address key clinical issues related to diagnosis, treatment, and patient management. Each issue adopts a problem-oriented approach, focusing on key questions and clearly outlining what is known while identifying areas for future research. Practical management strategies are described to facilitate application to individual patients. The series targets physicians in practice or training.
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