title: Place of cabergoline in acromegaly: a meta-analysis.
abstract: BACKGROUND
  Cabergoline is widely considered to be poorly effective in acromegaly.
  
  
  OBJECTIVE
  The aim of this study was to obtain a more accurate picture of the efficacy of cabergoline in acromegaly, both alone and in combination with somatostatin analogs.
  
  
  METHODS
  We systematically reviewed all trials of cabergoline therapy for acromegaly published up to 2009 in four databases (PubMed, Pascal, Embase, and Google Scholar). We identified 15 studies (11 prospective) with a total of 237 patients; none were randomized or placebo-controlled. A meta-analysis was conducted on individual data (n = 227).
  
  
  RESULTS
  Cabergoline was used alone in nine studies. Fifty-one (34%) of the 149 patients achieved normal IGF-I levels. In multivariate analysis, the decline in IGF-I was related to the baseline IGF-I concentration (β = 1.16; P <0.001), treatment duration (β = 0.28; P < 0.001), and baseline prolactin concentration (β = -0.18; P = 0.01), and with a trend toward a relation with the cabergoline dose (β = 0.38; P =0.07). In five studies, cabergoline was added to ongoing somatostatin analog treatment that had failed to normalize IGF-I. Forty patients (52%) achieved normal IGF-I levels. The change in IGF-I was significantly related to the baseline IGF-I level (β = 0.74; P < 0.001) but not to the dose of cabergoline, the duration of treatment, or the baseline prolactin concentration.
  
  
  CONCLUSIONS
  This meta-analysis suggests that cabergoline single-agent therapy normalizes IGF-I levels in one third of patients with acromegaly. When a somatostatin analog fails to control acromegaly, cabergoline adjunction normalizes IGF-I in about 50% of cases. This effect may occur even in patients with normoprolactinemia.
authors.affiliation: Université Paris-Sud, Faculté de Médecine Paris-Sud, Unité Mixte de Recherche-S693, F-94276 Le Kremlin Bicêtre, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Sandret
authors.forename: Patrick
authors.initials: P
authors.lastname: Maison
authors.forename: Philippe
authors.initials: P
authors.lastname: Chanson
mesh_terms: D000172:Acromegaly / Q000188:drug therapy* / Q000473:pathology; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000077465:Cabergoline; D003627:Data Interpretation, Statistical; D004873:Ergolines / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000188:drug therapy / Q000473:pathology; D006727:Hormone Antagonists / Q000627:therapeutic use; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D006966:Hyperprolactinemia / Q000188:drug therapy / Q000209:etiology; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D004873:Ergolines; D006727:Hormone Antagonists; D019382:Human Growth Hormone; D013004:Somatostatin; D007334:Insulin-Like Growth Factor I; D000077465:Cabergoline