Recurrence of hyperprolactinemia after withdrawal of dopamine agonists: systematic review and meta-analysis.
BACKGROUND
Dopamine agonists are the treatment of choice for prolactinomas and symptomatic idiopathic hyperprolactinemia. However, the optimal treatment strategy and treatment duration is not clear in all details.


OBJECTIVE
The aim of the study was to assess the effect of dopamine agonist withdrawal in patients with idiopathic hyperprolactinemia and prolactinomas.


METHODS
PubMed, the Cochrane Library, the Web of Science, and EMBASE were searched electronically. No restriction was made with respect to language.


METHODS
Studies reporting the proportion of normoprolactinemic patients after withdrawal of dopamine agonist or studies in which this proportion could be calculated were eligible. Both observational studies and clinical trials were eligible. Nineteen studies were included in the meta-analysis, with a total of 743 patients.


METHODS
Data extraction was performed by two reviewers independently.


RESULTS
The pooled proportion of patients with persisting normoprolactinemia after dopamine agonist withdrawal was 21% in a random effects model [95% confidence interval (CI), 14-30%; I(2) 81%). Stratified analysis showed higher proportions of treatment success in idiopathic hyperprolactinemia (32%; 95% CI, 5-80%), compared with both microprolactinomas (21%; 95% CI, 10-37%), and macroprolactinomas (16%; 95% CI, 6-36%). In a random effects meta-regression adjusting for cause of hyperprolactinemia, a longer treatment duration was associated with treatment success (P = 0.015), whereas the use of cabergoline showed a trend of effect (P = 0.07).


CONCLUSIONS
This meta-analysis showed that hyperprolactinemia will recur after dopamine agonist withdrawal in a considerable proportion of patients. The probability of treatment success was highest when cabergoline was used for at least 2 yr.
Dekkers
Olaf M
OM
Department of Endocrinology and Metabolic Diseases, C4-R, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. o.m.dekkers@lumc.nl
Lagro
Joep
J
Burman
Pia
P
Jørgensen
Jens Otto
JO
Romijn
Johannes A
JA
Pereira
Alberto M
AM
D018491:Dopamine Agonists / Q000627:therapeutic use*; D006801:Humans; D006966:Hyperprolactinemia / Q000150:complications / Q000188:drug therapy*; D010911:Pituitary Neoplasms / Q000150:complications / Q000188:drug therapy; D015175:Prolactinoma / Q000150:complications / Q000188:drug therapy; D012008:Recurrence; D016896:Treatment Outcome; D028761:Withholding Treatment
D018491:Dopamine Agonists