title: Remission of acromegaly after treatment withdrawal in patients controlled by cabergoline alone or in combination with octreotide: results from a multicenter study.
abstract: OBJECTIVE
  Remission of acromegaly has been reported after somatostatin analogs withdrawal, but not after withdrawal of combination therapy with cabergoline, and only in case reports of patients controlled by cabergoline alone.
  
  
  METHODS
  To establish the remission rates (normal IGF-1 for age/sex: IGF-1 ≤ 1.00 xULN) after withdrawal of combined treatment with octreotide LAR and cabergoline and of cabergoline alone, we prospectively studied 16 patients with acromegaly controlled by those treatments in the preceding 2 years as part of a larger study on remission of acromegaly after withdrawal of different medical treatments.
  
  
  RESULTS
  Among 97 patients with controlled acromegaly included in the entire study, only 16 patients had been on combination therapy (n = 12) or cabergoline alone (n = 4). At 8 weeks after treatment withdrawal, three patients (19%) were in remission (short-term remission). At 60 weeks (long-term remission), IGF-1 levels were still in the normal range in two patients (12.5%) and remained normal up to 108 weeks after treatment withdrawal (last visit). One patient had been treated with cabergoline alone and another one with combination of octreotide and cabergoline before treatment withdrawal.
  
  
  CONCLUSIONS
  Remission of acromegaly after treatment withdrawal seems to be uncommon in patients controlled by cabergoline, either as monotherapy or in combination with octreotide. In the future, larger studies and/or meta-analysis will be necessary to accurately establish the remission rates of acromegaly after withdrawal of cabergoline with or without somatostatin analogs.
authors.affiliation: Neuroendocrine Unit, Division of Endocrinology and Metabolism, Universidade Federal de São Paulo, Rua Botucatu, 806, Vila Clementino, São Paulo, SP, CEP 04023-062, Brazil.
authors.forename: A
authors.initials: A
authors.lastname: Casagrande
authors.affiliation: Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil.
authors.forename: M D
authors.initials: MD
authors.lastname: Bronstein
authors.affiliation: Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil.
authors.forename: R S
authors.initials: RS
authors.lastname: Jallad
authors.affiliation: Division of Endocrinology, General Hospital of Fortaleza, Fortaleza, Brazil.
authors.forename: J I
authors.initials: JI
authors.lastname: Mota
authors.affiliation: Endocrine Division, Department of Internal Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: A
authors.initials: A
authors.lastname: Tabet
authors.affiliation: Neuroendocrine Unit, Division of Endocrinology and Metabolism, Universidade Federal de São Paulo, Rua Botucatu, 806, Vila Clementino, São Paulo, SP, CEP 04023-062, Brazil. julioabucham@uol.com.br.
authors.forename: J
authors.initials: J
authors.lastname: Abucham
mesh_terms: D000172:Acromegaly / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000077465:Cabergoline; D004873:Ergolines / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage; D011379:Prognosis; D011446:Prospective Studies; D012074:Remission Induction; D028761:Withholding Treatment
chemical_list: D004873:Ergolines; D000077465:Cabergoline; D015282:Octreotide
keywords: Acromegaly; Cabergoline; Combination therapy; Octreotide; Remission