Ferriere A, Cortet C, Chanson P, Delemer B, Caron P, Chabre O, Reznik Y, Bertherat J, Rohmer V, Briet C, Raingeard I, Castinetti F, Beckers A, Vroonen L, Maiter D, Cephise-Velayoudom F L, Nunes M L, Haissaguerre M, Tabarin A
CHU BordeauxHôpital Haut-Lévêque, Service d'Endocrinologie, Diabétologie et Nutrition, Pessac, France or INSERM U862, Neurocentre Magendie, Université Bordeaux, Bordeaux Cedex, France.
CHRU LilleService d'Endocrinologie, Diabétologie et Métabolisme, Lille Cedex, France.
Eur J Endocrinol. 2017 Mar;176(3):305-314. doi: 10.1530/EJE-16-0662. Epub 2016 Dec 22.
The efficacy of cabergoline in Cushing's disease (CD) is controversial. The aim of this study was to assess the efficacy and tolerability of cabergoline in a large contemporary cohort of patients with CD.
We conducted a retrospective multicenter study from thirteen French and Belgian university hospitals.
Sixty-two patients with CD received cabergoline monotherapy or add-on therapy. Symptom score, biological markers of hypercortisolism and adverse effects were recorded.
Twenty-one (40%) of 53 patients who received cabergoline monotherapy had normal urinary free cortisol (UFC) values within 12 months (complete responders), and five of these patients developed corticotropic insufficiency. The fall in UFC was associated with significant reductions in midnight cortisol and plasma ACTH, and with clinical improvement. Compared to other patients, complete responders had similar median baseline UFC (2.0 vs 2.5xULN) and plasma prolactin concentrations but received lower doses of cabergoline (1.5 vs 3.5 mg/week, P < 0.05). During long-term treatment (>12 months), cabergoline was withdrawn in 28% of complete responders because of treatment escape or intolerance. Overall, sustained control of hypercortisolism was obtained in 23% of patients for 32.5 months (19-105). Nine patients on steroidogenesis inhibitors received cabergoline add-on therapy for 19 months (1-240). Hypercortisolism was controlled in 56% of these patients during the first year of treatment with cabergoline at 1.0 mg/week (0.5-3.5).
About 20-25% of CD patients are good responders to cabergoline therapy allowing long-term control of hypercortisolism at relatively low dosages and with acceptable tolerability. No single parameter, including the baseline UFC and prolactin levels, predicted the response to cabergoline.
卡麦角林治疗库欣病（CD）的疗效存在争议。本研究旨在评估卡麦角林在当代大量CD患者队列中的疗效和耐受性。
我们进行了一项来自13家法国和比利时大学医院的回顾性多中心研究。
62例CD患者接受卡麦角林单药治疗或联合治疗。记录症状评分、高皮质醇血症的生物学标志物和不良反应。
53例接受卡麦角林单药治疗的患者中有21例（40%）在12个月内尿游离皮质醇（UFC）值正常（完全缓解者），其中5例患者出现促肾上腺皮质激素功能不全。UFC的下降与午夜皮质醇和血浆促肾上腺皮质激素（ACTH）的显著降低以及临床改善相关。与其他患者相比，完全缓解者的基线UFC中位数（2.0 vs 2.5倍正常上限）和血浆催乳素浓度相似，但接受的卡麦角林剂量较低（1.5 vs 3.5mg/周，P<0.05）。在长期治疗（>12个月）期间，28%的完全缓解者因治疗失败或不耐受而停用卡麦角林。总体而言，23%的患者在32.5个月（19 - 105个月）内实现了高皮质醇血症的持续控制。9例接受类固醇生成抑制剂治疗的患者接受了19个月（1 - 240个月）的卡麦角林联合治疗。在使用卡麦角林1.0mg/周（0.5 - 3.5mg/周）治疗的第一年，56%的患者高皮质醇血症得到控制。
约20 - 25%的CD患者对卡麦角林治疗反应良好，能够以相对低剂量且可接受的耐受性实现高皮质醇血症的长期控制。没有单一参数，包括基线UFC和催乳素水平，能够预测对卡麦角林的反应。
