Graduate Program in Medical Sciences: Endocrinology, Faculty of Medicine, UFRGS, Porto Alegre, Brazil.
Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Front Endocrinol (Lausanne). 2023 May 8;14:1145775. doi: 10.3389/fendo.2023.1145775. eCollection 2023.
The first-line treatment for Cushing's disease is transsphenoidal surgery for pituitary tumor resection. Ketoconazole has been used as a second-line drug despite limited data on its safety and efficacy for this purpose. The objective of this meta-analysis was to analyze hypercortisolism control in patients who used ketoconazole as a second-line treatment after transsphenoidal surgery, in addition to other clinical and laboratory criteria that could be related to therapeutic response.
We searched for articles that evaluated ketoconazole use in Cushing's disease after transsphenoidal surgery. The search strategies were applied to MEDLINE, EMBASE, and SciELO. Independent reviewers assessed study eligibility and quality and extracted data on hypercortisolism control and related variables such as therapeutic dose, time, and urinary cortisol levels.
After applying the exclusion criteria, 10 articles (one prospective and nine retrospective studies, totaling 270 patients) were included for complete data analysis. We found no publication bias regarding reported biochemical control or no biochemical control (p = 0.06 and p = 0.42 respectively). Of 270 patients, biochemical control of hypercortisolism occurred in 151 (63%, 95% CI 50-74%) and no biochemical control occurred in 61 (20%, 95% CI 10-35%). According to the meta-regression, neither the final dose, treatment duration, nor initial serum cortisol levels were associated with biochemical control of hypercortisolism.
Ketoconazole can be considered a safe and efficacious option for Cushing's disease treatment after pituitary surgery.
https://www.crd.york.ac.uk/prospero/#searchadvanced, (CRD42022308041).
库欣病的一线治疗方法是经蝶窦垂体瘤切除术。酮康唑已被用作二线药物，尽管其在该用途的安全性和疗效方面的数据有限。本荟萃分析的目的是分析在经蝶窦手术后使用酮康唑作为二线治疗的患者中，皮质醇过多症的控制情况，以及可能与治疗反应相关的其他临床和实验室标准。
我们搜索了评估经蝶窦手术后酮康唑在库欣病中应用的文章。搜索策略应用于 MEDLINE、EMBASE 和 SciELO。独立评审员评估研究的合格性和质量，并提取皮质醇过多症控制和相关变量的数据，如治疗剂量、时间和尿皮质醇水平。
应用排除标准后，10 篇文章（一项前瞻性和九项回顾性研究，共 270 名患者）被纳入进行完整数据分析。我们发现，关于报告的生化控制或无生化控制，没有发表偏倚（分别为 p = 0.06 和 p = 0.42）。在 270 名患者中，151 名（63%，95%CI 50-74%）出现皮质醇过多症的生化控制，61 名（20%，95%CI 10-35%）出现无生化控制。根据荟萃回归分析，最终剂量、治疗持续时间和初始血清皮质醇水平均与皮质醇过多症的生化控制无关。
酮康唑可被视为垂体手术后库欣病治疗的一种安全有效的选择。
https://www.crd.york.ac.uk/prospero/#searchadvanced,（CRD42022308041）。
