Cabergoline Is Alternative Option for Treatment of Cushing’s Disease, Meta-analysis Suggests

Medical therapy using cabergoline is an option for treating patients with persistent or recurrent Cushing’s disease after transsphenoidal surgery, new research from India shows.

The study, “Effect of cabergoline monotherapy in Cushing’s disease: an individual participant data meta‑analysis,” was published in the Journal of Endocrinological Investigation.

Cushing’s disease is most commonly caused by a type of pituitary tumor called an adenoma. The first-line treatment of Cushing’s is removal of the pituitary adenoma using transsphenoidal surgery (TSS), an approach where the surgeon inserts a tiny endoscope through the nose to remove the tumor.

Overall, 78% of patients achieve remission after their first surgery for a pituitary adenoma. But half of patients with large tumors and a quarter of those with smaller tumors require additional treatment due to persistent or recurrent Cushing’s disease.

Repeat TSS, radiation therapy, bilateral adrenalectomy (removal of both adrenal glands), and medical treatment are all options for treatment of recurrent or persistent Cushing’s.

Medication is often a good option for treatment because it can be used in patients as either a bridge therapy for those waiting for surgery or for those who cannot or do not want to undergo surgery.

Cabergoline, marketed as Dostinex, is a type of drug known as a dopamine receptor agonist. It has been shown to be effective in the management of non-functioning pituitary adenomas.

However, only a few small observational studies have been conducted to evaluate the cabergoline option in Cushing’s disease patients.

Researchers set out to determine the safety and effectiveness of using cabergoline monotherapy in Cushing’s patients and to find any factors that can predict the patient’s response to the therapy.

The primary outcome of this study was to find the proportion of patients who achieved Cushing’s disease remission following the option of taking cabergoline as a monotherapy.

Researchers explored published literature and found data on 124 patients in six observational studies who were included in this meta-analysis. Among the participants, 74.2% had prior pituitary surgery.

Results indicated that the proportion of patients achieving remission in Cushing’s disease after being treated with cabergoline monotherapy was 39.4%.

Factors such as previous surgery, duration of cabergoline monotherapy, and the maximum dose of cabergoline were also predictors for Cushing’s remission.

Specifically, patients whose maximum cabergoline dose was lower and those who were treated longer were more likely to respond to cabergoline.

Mild side effects were reported in 37.3% of patients, while severe side effects were seen in 5.6% of patients during cabergoline monotherapy.

Results from this study indicate that cabergoline monotherapy is a reasonable option for patients with persistent or recurrent Cushing’s disease after TSS.

“It can also be used in [Cushing’s] patients either as a bridge therapy while waiting for surgery or in those unwilling for surgery or have contraindication to it,” researchers wrote.

“However, further studies, preferably randomized control trials comparing cabergoline with other standard treatments of [Cushing’s], are needed to generate [a] better quality of evidence,” they added.