Department of Endocrinology and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Clin Endocrinol (Oxf). 2022 Nov;97(5):519-531. doi: 10.1111/cen.14714. Epub 2022 Mar 22.
To estimate the proportion of patients with persistent normoprolactinaemia following dopamine agonist (DA) withdrawal and to identify predictors of successful withdrawal in patients with hyperprolactinaemia.
DESIGN, PATIENTS, AND MEASUREMENTS: A systematic review of observational eligible studies were identified by searching PubMed and Embase. The primary outcome was the proportion of patients with normoprolactinaemia after cessation of DA treatment. Secondary outcome included the proportion of patients with normoprolactinaemia after DA withdrawal using individual patient data. Risk of bias was assessed by using Newcastle-Ottawa Scale. Pooled proportions were estimated using a random effects model in case I ≤ 75% or by reporting range of effects if I > 75%.
Thirty-two observational studies enroling 1563 patients were included. The proportion of patients with persistent normoprolactinaemia ranged from 0% to 75% (I = 84%). Heterogeneity was partly explained by age with more successful withdrawal in patients of higher age. Individual patient data analyses suggested that the proportion of patients with persistent normoprolactinaemia 6 months after DA withdrawal with a low maintenance dose and full regression of the prolactinoma was 87.7% (95% confidence interval [CI] = 60.7-97.1; I = 0%) and 58.4% (95% CI = 23.8-86.3; I = 75%) for microadenomas and macroadenomas, respectively.
The proportion of patients with persistent normoprolactinaemia following DA withdrawal treatment varied greatly, partly explained by the mean age of participants of the individual studies. Individual patient data analysis suggested that successful withdrawal was likely in patients with full regression of prolactinomas using a low maintenance dose before cessation.
评估多巴胺激动剂（DA）停药后持续性正常催乳素血症患者的比例，并确定高催乳素血症患者成功停药的预测因素。
设计、患者和测量方法：通过搜索 PubMed 和 Embase，确定了符合条件的观察性研究的系统评价。主要结局是停止 DA 治疗后催乳素正常的患者比例。次要结局包括使用个体患者数据的 DA 停药后催乳素正常的患者比例。使用纽卡斯尔-渥太华量表评估偏倚风险。如果 I ² ≤ 75%，使用随机效应模型估计汇总比例；如果 I ² ＞ 75%，则报告效应范围。
共纳入 32 项观察性研究，共纳入 1563 例患者。持续存在催乳素正常的患者比例范围为 0%至 75%（I ² = 84%）。异质性部分可以用年龄来解释，年龄较高的患者停药后效果更好。个体患者数据分析表明，DA 停药后 6 个月催乳素持续正常、且泌乳素瘤完全消退的患者中，低维持剂量和微腺瘤的比例分别为 87.7%（95%置信区间 [CI] = 60.7-97.1；I ² = 0%）和 58.4%（95% CI = 23.8-86.3；I ² = 75%），而对于大腺瘤，这一比例分别为 58.4%（95% CI = 23.8-86.3；I ² = 75%）。
DA 停药后催乳素持续正常的患者比例差异很大，部分原因是各研究中患者的平均年龄不同。个体患者数据分析表明，对于使用低维持剂量、停药前泌乳素瘤完全消退的患者，停药后可能成功。
