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Endocrine

, Volume 59, Issue 1, pp 50–61 | Cite as

Optimal timing of dopamine agonist withdrawal in patients with hyperprolactinemia: a systematic review and meta-analysis

  • Miao Yun Xia
  • Xiao Hui Lou
  • Shao Jian Lin
  • Zhe Bao Wu
Meta-Analysis

Abstract

Purpose

Dopamine agonists (DAs) are recommended as first-line treatment for patients with hyperprolactinemia. Generally, it is accepted that patients with hyperprolactinemia do not need lifelong medication, but the optimal timing for DA withdrawal has not been determined. The aim of this systematic review and meta-analysis is to assess the impact of DA withdrawal on the clinical outcomes of patients with hyperprolactinemia, and to explore possible factors affecting successful DA withdrawal.

Methods

The databases of PubMed, Cochrane and EMBASE were searched up to May 2016.

Results

The proportion of patients with persisting normoprolactinemia after DA withdrawal reached 36.6% in a random effects model (95% CI, 29.4–44.2%; I-squared: 82.5%). Data of stratified analysis showed that the success rate of drug withdrawal was high in patients using cabergoline (CAB) as the only treatment (41.2%; 95% CI 32.3–50.4%) and those using CAB over 24 months (48.7%; 95% CI 38.9–58.5%), especially in patients with idiopathic hyperprolactinemia (73.2%; 95% CI 55.6–87.7%). In addition, patients who received a low maintenance dose of CAB, and had a significant reduction in tumor size (over 50%) before withdrawal, were more likely to achieve success (51.5 and 49.4%, respectively).

Conclusion

The success rate of DA withdrawal has increased in recent years. Further, the success rate of CAB withdrawal was higher than that of bromocriptine, especially in patients with a duration of treatment longer than 24 months. Conclusively, the probability of success was higher in patients who received low-dose CAB maintenance treatment and those who achieved a significant reduction in tumor size before withdrawal.

Keywords

Dopamine agonists Withdrawal Hyperprolactinemia Prolactinoma Cabergoline Bromocriptine 

Notes

Acknowledgements

We thank Ms. Erin M. Botticelli of Massachusetts General Hospital for her careful reading and editing of the manuscript.

Funding

This work was supported by Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support (Grant No. 20161407), and the National Natural Science Foundation of China (Grant No. 81471392, 81271523).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Miao Yun Xia
    • 1
  • Xiao Hui Lou
    • 2
  • Shao Jian Lin
    • 1
  • Zhe Bao Wu
    • 1
  1. 1.Department of Neurosurgery, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
  2. 2.Department of NeurosurgeryThird Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina

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