Endocrine Abstracts (2011) 26 OC2.5

Risk of cardiac valve regurgitation with dopamine agonist use in Parkinson's disease and hyperprolactinemia

G Trifirò1,2, M Mokhles1, J Dieleman1, E van Soest1, G Mazzaglia3, R Herings4, C de Luise5, D Ross5, G Brusselle6, A Colao7, W Haverkamp8, R Schade1, G van Camp9, R Zanettini10 & M Sturkenboom1

1Erasmus Medical Center, Rotterdam, The Netherlands; 2IRCCS Centro Neurolesi Bonino-Pulejo, Messina, The Netherlands; 3Health Search, Florence, Italy; 4PHARMO Institute, Utrecht, The Netherlands; 5Pfizer Inc., New York, New York, USA; 6University of Ghent, Gent, Belgium; 7Federico II University, Naples, Italy; 8Universitätsmedizin Berlin, Berlin, Germany; 9UZ Brussel, Brussels, Belgium; 10Istituti Clinici di Perfezionamento, Milan, Italy.

Background: There is growing evidence that ergot dopamine agonists (DA) may induce cardiac valve regurgitation (CVR) in persons with Parkinson’s disease (PD). It is unclear whether the CVR risk is increased with ergot-DA use in persons with hyperprolactinemia, in whom the dose is much lower.

Objective: To assess the association between ergot and non-ergot DAs and CVR in patients with hyperprolactinemia and PD.

Methods: Nested case–control studies were separately conducted in two cohorts: i) DA-naïve patients and new users of DA with hyperprolactinemia; ii) PD patients who were newly treated with DA or Levodopa. The cohorts were identified from three general practice databases in Europe: THIN (UK), Health Search (Italy) and IPCI (NL). Cases of CVR were manually validated and matched to controls by age, gender, index date and database. Relative risks and 95% confidence intervals (CI) of CVR were estimated through conditional logistic regression for different DAs using non-use as reference in hyperprolactinemia cohort and levodopa in PD cohort.

Results: In the cohort of 21 044 patients with hyperprolactinemia, 37 cases of CVR were identified but no association between individual Ergot DAs and CVR was observed. In the cohort of 19 656 PD patients, 85 incident cases of CVR were identified during follow-up. Compared to levodopa the class of ergot-DAs was associated with CVR. Among individual drugs only cabergoline was associated with significantly increased risk of CVR (OR: 4.6; 95% CI: 2.4–8.8).

Conclusions: Increased risk of CVR was confirmed in PD patients who were treated only with ergot-DAs, mostly due to cabergoline. On the other hand, ergot-DA use in patients with hyperprolactinemia was not associated with increased risk of CVR.