Abstract
Cabergoline and bromocriptine are the most used drugs in the treatment of hyperprolactinemia, they are able to normalize the prolactin levels, restore gonadal function and promote tumor reduction in the majority of patients. We undertake a systematic review and meta-analysis of randomized controlled trials to compare cabergoline versus bromocriptine in the treatment of patients with idiopathic hyperprolactinemia and prolactinomas. The data sources were: Embase, Pubmed, Lilacs and Cochrane Central. The outcome measures were: normalization of prolactin secretion, restoration of gonadal function, reduction of tumoral volume, quality of life and adverse drug effects. Were identified 418 references and after screening by title and abstract, we obtained complete copies of 34 articles potentially eligible for inclusion in the review. From this total, 19 were selected to be included, but fifteen of them were excluded due to the following reasons: one randomized study compared cabergoline versus placebo and other randomized study compared different doses of cabergoline; five references were cases series; four were only controlled studies; three were retrospectives series and; one was a cohort study. Therefore, four publications were included in the review and in the final analysis. The meta-analysis of normalization of serum prolactin levels and menstruation with return of ovulatory cycle showed a significant difference in favor of cabergoline group (RR 0.67 [CI 95% 0.57, 0.80]) e (RR 0.74 [CI 95% 0.67, 0.83]), respectively. The number of adverse effects was significantly higher in the bromocriptine number than in cabergoline group (RR 1.43 [CI 95% 1.03, 1.98]). The meta-analysis showed new evidence favoring the use of cabergoline in comparison with bromocriptine for the treatment of prolactinomas and idiopathic hyperprolactinemia.
Similar content being viewed by others
References
Brue T, Delemer B (2007) Diagnosis and management of hyperprolactinemia: expert consensus—French society of endocrinology. Ann Endocrinol (Paris) 68:58–64
Casanueva FF et al (2006) Guidelines of the pituitary society for the diagnosis and management of prolactinomas. Clin Endocrinol (Oxf) 65:265–273
Colao A, di Sarno A, Pivonello R, di Somma C, Lombardi G (2002) Dopamine receptor agonists for treating prolactinomas. Expert Opin Investig Drugs 11:787–800
Colao A, Pivonello R, Di Somma C, Savastano S, Grasso LF, Lombardi G (2009) Medical therapy of pituitary adenomas: effects on tumor shrinkage. Rev Endocr Metab Disord 10:111–123
Verhelst J, Abs R, Maiter D, van den Bruel A, Vandeweghe M, Velkeniers B, Mockel J, Lamberigts G, Petrossians P, Coremans P, Mahler C, Stevenaert A, Verlooy J, Raftopoulos C, Beckers A (1999) Cabergoline in the treatment of hyperprolactinemia: a study in 455 patients. J Clin Endocrinol Metab 8:2518–2522
Colao A, Di Sarno A, Landi ML, Scavuzzo F, Cappabianca P, Pivonello R, Volpe R, Di Salle F, Cirillo S, Annunziato L, Lombardi G (2000) Macroprolactinoma shrinkage during cabergoline treatment is greater in naive patients than in patients pretreated with other dopamine agonists: a prospective study in 110 patients. J Clin Endocrinol Metab 85:2247–2252
Alderson P, Green S, Higgins JPT (eds) (2004) Cochrane reviewers’ handbook 4.2.2 the Cochrane library [updated December 2003]. Wiley, Chichester
Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560
Webster J, Piscitelli G, Polli A, D’Alberton A, Falsetti L, Ferrari C, Fioretti P, Giordano G, L’Hermite M, Ciccarelli E et al (1992) Dose-dependent suppression of serum prolactin by cabergoline in hyperprolactinaemia: a placebo controlled, double blind, multicentre study. European multicentre cabergoline dose-finding study group. Clin Endocrinol (Oxf) 37:534–541
Mattei AM, Ferrari C, Baroldi P, Cavioni V, Paracchi A, Galparoli C, Romano C, Spellecchia D, Gerevini G, Crosignani PG (1988) Prolactin-lowering effect of acute and once weekly repetitive oral administration of cabergoline at two dose levels in hyperprolactinemic patients. J Clin Endocrinol Metab 66:193–198
Bricaire C (2004) Interruption d’un traitement de longue durée par la cabergoline des hyperprolactinémies tumorales et non tumorales. La Revue du Praticien Gynécologie et Obstétrique 15:9–10
Freda PU, Reyes CM, Nuruzzaman AT, Sundeen RE, Khandji AG, Post KD (2004) Cabergoline therapy of growth hormone & growth hormone/prolactin secreting pituitary tumors. Pituitary 7:21–30
Di Somma C, Colao A, Di Sarno A, Klain M, Landi ML, Facciolli G, Pivonello R, Panza N, Salvatore M, Lombardi G (1998) Bone marker and bone density responses to dopamine agonist therapy in hyperprolactinemic males. J Clin Endocrinol Metab 83:807–813
Bolko P, Jaskula M, Wasko R, Wolun M, Sowinski J (2003) The assessment of cabergoline efficacy and tolerability in patients with pituitary prolactinoma type. Pol Arch Med Wewn 109:489–495
Ferrari C, Barbieri C, Caldara R, Mucci M, Codecasa F, Paracchi A, Romano C, Boghen M, Dubini A (1986) Long-lasting prolactin-lowering effect of cabergoline, a new dopamine agonist, in hyperprolactinemic patients. J Clin Endocrinol Metab 63:941–945
Di Sarno A, Landi ML, Cappabianca P, Di Salle F, Rossi FW, Pivonello R, Di Somma C, Faggiano A, Lombardi G, Colao A (2001) Resistance to cabergoline as compared with bromocriptine in hyperprolactinemia: prevalence, clinical definition, and therapeutic strategy. J Clin Endocrinol Metab 86:5256–5261
De Rosa M, Colao A, Di Sarno A, Ferone D, Landi ML, Zarrilli S, Paesano L, Merola B, Lombardi G (1998) Cabergoline treatment rapidly improves gonadal function in hyperprolactinemic males: a comparison with bromocriptine. Eur J Endocrinol 138:286–293
Fideleff HL, Holland M, Chervin A, Gurucharri C, Sinai I (1997) Tratamiento de amenorreas hiperprolactinemicas con cabergolina. Medicina (B Aires) 57:657–661
Sartorio A, Conti A, Ambrosi B, Muratori M, Morabito F, Faglia G (1990) Osteocalcin levels in patients with microprolactinoma before and during medical treatment. J Endocrinol Invest 13:419–422
Vilar L et al (2008) Diagnosis and management of hyperprolactinemia: results of a Brazilian multicenter study with 1234 patients. J Endocrinol Invest 31:436–444
Berinder K, Stackenas I, Akre O, Hirschberg AL, Hulting AL (2005) Hyperprolactinaemia in 271 women: up to three decades of clinical follow-up. Clin Endocrinol (Oxf) 63:450–455
Cesar de Oliveira Naliato E, Dutra Violante AH, Caldas D, Lamounier Filho A, Rezende Loureiro C, Fontes R, Schrank Y, Gomes de Souza R, Vaisman M, Guerra E, Sebastian A, Colao A (2008) Quality of life in women with microprolactinoma treated with dopamine agonists. Pituitary 11:247–254
Al -Husaynei A, Mahmood I, Al -Jubori ZS (2008) Comparison of the effects of cabergoline and bromocriptine in women with hyperprolactinemic amenorrhea. Middle East Fertil Soc J 13:33–38
Sabuncu T, Arikan E, Tasan E, Hatemi H (2001) Comparison of the effects of cabergoline and bromocriptine on prolactin levels in hyperprolactinemic patients. Intern Med 40:857–861
Pascal-Vigneron V, Weryha G, Bosc M, Leclere J (1995) Aménorrhée hyperprolactinémique: traitement par cabergoline versus bromocriptine. Résultats de l’étude nationale, multicentrique, randomisée en double insu. La Presse Médicale 20:753–757
Webster J, Piscitelli G, Polli A, Ferrari CI, Ismail I, Scanlon MF (1994) A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. Cabergoline comparative study group. N Engl J Med 331:904–909
Ferrari CI, Abs R, Bevan JS, Brabant G, Ciccarelli E, Motta T, Mucci M, Muratori M, Musatti L, Verbessem G, Scanlon MF (1997) Treatment of macroprolactinoma with cabergoline: a study of 85 patients. Clin Endocrinol (Oxf) 46:409–413
Acknowledgments
This work was supported by Brazilian National Research Council, CNPq; grant N# 576445/08-8.
Conflict interests
Nothing to declare.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
dos Santos Nunes, V., El Dib, R., Boguszewski, C.L. et al. Cabergoline versus bromocriptine in the treatment of hyperprolactinemia: a systematic review of randomized controlled trials and meta-analysis. Pituitary 14, 259–265 (2011). https://doi.org/10.1007/s11102-010-0290-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11102-010-0290-z