Discontinuation of Drug Treatment in Cushing's Disease Not Cured by Pituitary Surgery
Authors' conclusion
DT allowed at least 1 normal UFC in 23/29 patients (79%) but obtained long-term control in only 11/29 (38%), as discontinuation rate was high, although similar to published data. Interestingly, a successful 2nd TSS was the cause for discontinuing efficient and well-tolerated DT in 5 patients. Further studies will show whether different strategies with cortisol synthesis inhibitors may allow for a lower discontinuation rate in patients not candidates for a 2nd TSS so that BA may be avoided in these patients.
Study context
- Population
- Patients with Cushing's disease (CD) not cured by first transsphenoidal surgery (TSS) (19 TSS failure, 17 recurrence), out of 119 patients with CD treated by a first TSS; average follow-up 6.1 years
- Participants
- 29 / 16 / 14 / 5
- Exposure
- Drug treatment (DT) vs 2nd TSS vs bilateral adrenalectomy (BA) vs pituitary radiotherapy (PR)
- DTn = 29
- 2nd TSSn = 16
- BAn = 14
- PRn = 5
- Outcome
- Long-term continuation of DT; control defined as normalization of UFC, final treatment (FT) as the treatment allowing control at last follow-up
- Follow-up
- Last
Methodological detailssingle-centre, centre prioritizing 2nd TSS
- Single-centre
- Centre prioritizing 2nd TSS
Main finding
As reported in the abstract
| Group | Value | Initiated | At least 1 normal urinary free cortisol (UFC) | Discontinued before last follow-up | Final treatment (FT) |
|---|---|---|---|---|---|
| DT | 38% | 29/36 (81%) | 23/29 (79%) | 18/29 (62%) | 11/29 (38%) |
| 2nd TSS | 50% | 8/16 (50%) | |||
| BA | 100% | 14/14 (100%) | |||
| PR | 0 events | 0/5 |
Value
Initiated
At least 1 normal urinary free cortisol (UFC)
Discontinued before last follow-up
Final treatment (FT)
- Control achieved (all patients)
- 33/36 (92%)
Observational data: associations, not effects.
Further findings
Discontinuation of DT in published CD prospective clinical trials
- Discontinuation at 1 year
- 11% to 51%
- Discontinuation before 5 years
- 32% to 74%
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Composed by AI from the published abstract and checked against it. How Briefs are made →