Withdrawal of dopamine agonist treatment in patients with hyperprolactinaemia. A systematic review and meta-analysis

Ida Brandt Andersen; Marie Gry Rejkjaer Sørensen; Sema Ciftci Dogansen; Cheol Ryoung Ku; Lucio Vilar; Ulla Feldt-Rasmussen; Jesper Krogh

doi:10.1111/cen.14714

Withdrawal of dopamine agonist treatment in patients with hyperprolactinaemia. A systematic review and meta-analysis

Ida Brandt Andersen, Marie Gry Rejkjaer Sørensen, Sema Ciftci Dogansen, Cheol Ryoung Ku, Lucio Vilar, Ulla Feldt-Rasmussen, Jesper Krogh^*

^*Corresponding author for this work

7 Citations (Scopus)

Abstract

OBJECTIVE: 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 I2 ≤ 75% or by reporting range of effects if I2 > 75%.

RESULTS: Thirty-two observational studies enroling 1563 patients were included. The proportion of patients with persistent normoprolactinaemia ranged from 0% to 75% (I2 = 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; I2 = 0%) and 58.4% (95% CI = 23.8-86.3; I2 = 75%) for microadenomas and macroadenomas, respectively.

CONCLUSIONS: 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.

Original language	English
Journal	Clinical Endocrinology
Volume	97
Issue number	5
Pages (from-to)	519-531
Number of pages	13
ISSN	0300-0664
DOIs	https://doi.org/10.1111/cen.14714
Publication status	Published - Nov 2022

Keywords

Dopamine Agonists/adverse effects
Humans
Hyperprolactinemia/chemically induced
Pituitary Neoplasms/complications
Prolactinoma/complications
Withholding Treatment

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10.1111/cen.14714

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title = "Withdrawal of dopamine agonist treatment in patients with hyperprolactinaemia. A systematic review and meta-analysis",

abstract = "OBJECTIVE: 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 I2 ≤ 75% or by reporting range of effects if I2 > 75%.RESULTS: Thirty-two observational studies enroling 1563 patients were included. The proportion of patients with persistent normoprolactinaemia ranged from 0% to 75% (I2 = 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; I2 = 0%) and 58.4% (95% CI = 23.8-86.3; I2 = 75%) for microadenomas and macroadenomas, respectively.CONCLUSIONS: 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.",

keywords = "Dopamine Agonists/adverse effects, Humans, Hyperprolactinemia/chemically induced, Pituitary Neoplasms/complications, Prolactinoma/complications, Withholding Treatment",

author = "Andersen, {Ida Brandt} and S{\o}rensen, {Marie Gry Rejkjaer} and Dogansen, {Sema Ciftci} and Ku, {Cheol Ryoung} and Lucio Vilar and Ulla Feldt-Rasmussen and Jesper Krogh",

year = "2022",

month = nov,

doi = "10.1111/cen.14714",

language = "English",

volume = "97",

pages = "519--531",

journal = "Clinical Endocrinology",

issn = "0300-0664",

publisher = "Wiley-Blackwell Publishing Ltd",

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TY - JOUR

T1 - Withdrawal of dopamine agonist treatment in patients with hyperprolactinaemia. A systematic review and meta-analysis

AU - Andersen, Ida Brandt

AU - Sørensen, Marie Gry Rejkjaer

AU - Dogansen, Sema Ciftci

AU - Ku, Cheol Ryoung

AU - Vilar, Lucio

AU - Feldt-Rasmussen, Ulla

AU - Krogh, Jesper

PY - 2022/11

Y1 - 2022/11

N2 - OBJECTIVE: 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 I2 ≤ 75% or by reporting range of effects if I2 > 75%.RESULTS: Thirty-two observational studies enroling 1563 patients were included. The proportion of patients with persistent normoprolactinaemia ranged from 0% to 75% (I2 = 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; I2 = 0%) and 58.4% (95% CI = 23.8-86.3; I2 = 75%) for microadenomas and macroadenomas, respectively.CONCLUSIONS: 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.

AB - OBJECTIVE: 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 I2 ≤ 75% or by reporting range of effects if I2 > 75%.RESULTS: Thirty-two observational studies enroling 1563 patients were included. The proportion of patients with persistent normoprolactinaemia ranged from 0% to 75% (I2 = 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; I2 = 0%) and 58.4% (95% CI = 23.8-86.3; I2 = 75%) for microadenomas and macroadenomas, respectively.CONCLUSIONS: 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.

KW - Dopamine Agonists/adverse effects

KW - Humans

KW - Hyperprolactinemia/chemically induced

KW - Pituitary Neoplasms/complications

KW - Prolactinoma/complications

KW - Withholding Treatment

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U2 - 10.1111/cen.14714

DO - 10.1111/cen.14714

M3 - Review

C2 - 35261059

SN - 0300-0664

VL - 97

SP - 519

EP - 531

JO - Clinical Endocrinology

JF - Clinical Endocrinology

IS - 5

ER -

Withdrawal of dopamine agonist treatment in patients with hyperprolactinaemia. A systematic review and meta-analysis

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