Comparison of efficacy of cabergoline and bromocriptine retrospectively in patients with hyperprolactinemia
Serhat Isik1, Dilek Berker1, Yasemin Tutuncu1, Ufuk Ozuguz1, Ayse Arduc1, Gulhan Akbaba1, Yusuf Aydin2 & Serdar Guler1
Objective: Patients with hyperprolactinemia who require medical therapy are typically treated with dopamine agonists (DA). In most cases, medical therapy with DA normalizes the level of prolactin (PRL), restores gonadal function and fertility, and substantially reduces the size of the tumor. Here, we aimed to compare the efficacy of cabergoline (CAB) and bromocriptine (BRC) in hyperprolactinemic patients retrospectively.
Methods: Retrospective analysis of clinic records of 231 patients (mean age 34.0±10.6 (1666) years, 210 women and 21 men) who had received either CAB (n=190) or BRC (n=41) for a mean duration of 24.2±20.0 (6120) months.
Results: The mean age, sex distribution and treatment duration were similar in CAB and BRC groups (35.2±10.6 vs 32.5±7.2, P=0.113; 20/170 versus 1/20, P=0.102; 21.7±16.7 versus 28.0±24.6, P=0.078). Mean dosage was 1.6±1.5 mg/per week for CAB and 3.7±3.0 mg/day for BRC. Mean PRL levels (ng/ml) and tumor volume (cm3) at baseline and were higher in CAB group (220.3±524.5 vs 112.6±50.7, P=0.02; 0.58±2.05 vs 0.11±0.20, P=0.04, respectively). Percentage of patients with nontumoral hyperprolactinemia was higher in BRC group (31.7 vs 7.9%, respectively, P<0.001). Macroadenomas were more frequent in CAB group compared to BRC group among patients with tumoral hyperprolactinemia (20.7 vs 7.1%, P<0.001). Fifteen of patients with macroadenoma had surgery either before or after medical treatment. Before treatment frequency of galactorrhea, amenorrhea and irregular menses were similar between groups whereas BRC was preferred for patients with infertility. Eleven of 12 patients with visual field defects and 19 of 22 patients using antipsychotic were treated with CAB. After treatment relief of symptoms and mean PRL levels were similar between CAB and BRC groups (23.3±53.0 vs BRC 31.4±27.0, respectively, P=0.390). Altough baseline PRL levels and tumor volume were higher in CAB group, statistically significant tumor volume shrinkage (%) and decrease in PRL levels were obtained in BRC group (58.7±54.9, 34.8±42.8, P=0.041 and 48.4±42.2, 23.2±52.0, P=0.003, respectively).
Conclusions: Our data suggest that both of DA were effective in controlling symptoms associated with horman excess but CAB has been shown to be more effective in normalizing serum PRL levels and tumor shrinkage compared to BRC.