Quinagolide – a valuable treatment option for hyperprolactinaemia

Hyperprolactinaemia is characterised by gonadal dysfunction, including infertility and reduced libido and, if left untreated, is associated with an increased risk of long-term complications, such as osteoporosis. The first-line therapy for patients with hyperprolactinaemia is pharmacological intervention with a dopamine agonist. Currently, there are three dopamine agonists available for hyperprolactinaemia therapy: bromocriptine, quinagolide and cabergoline. Bromocriptine has a long history of use; however, a range of 5–18% of patients are reported to show bromocriptine resistance, with only partial lowering of plasma prolactin levels and an absence of tumour shrinkage. The newer dopamine agonists, quinagolide and cabergoline, offer improved efficacy over bromocriptine, with a lower incidence of adverse events. Quinagolide and cabergoline have also demonstrated efficacy in many patients intolerant or resistant to bromocriptine. Thus, the selection of dopamine agonists available provides more than one option for pharmacological intervention of hyperprolactinaemia. This review discusses the clinical use of quinagolide in comparison to other dopamine agonists for hyperprolactinaemia therapy. Quinagolide may improve patient compliance to treatment owing to its reduced side effect profile, simple and rapid titration over just 7 days, once-daily dosing regimen and easy to use starter pack (available in some countries). Quinagolide offers an additional benefit for patients wishing to become pregnant, as it can be used until the point of confirmation of pregnancy. Therefore, as a well tolerated and effective therapy, with a simple dosing regimen, quinagolide should be considered as a first-line therapy in the treatment of hyperprolactinaemia.

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Analysis of Falls in Older Adults with Multiple Myeloma Undergoing First-Line Therapy

Blood ◽

10.1182/blood-2019-129611 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 5886-5886

Author(s):

Kelly L. Schoenbeck ◽

Tanya M. Wildes ◽

Mark A. Fiala

Keyword(s):

Older Adults ◽

Multiple Myeloma ◽

Peripheral Neuropathy ◽

First Line ◽

First Line Therapy ◽

Line Therapy ◽

Increased Risk ◽

Risk Of Falls ◽

Falls In Older Adults ◽

First Line Treatment

Background: Patients with multiple myeloma are frequently treated with bortezomib, a proteasome inhibitor, which is associated with treatment-related peripheral neuropathy. Older adults are at increased risk of falls compared to the general population, often leading to associated morbidity and mortality. While an association between peripheral neuropathy and falls in older adults is well-established, the relationship between bortezomib and falls in older multiple myeloma patients is unknown. Our primary aim was to determine if older patients with multiple myeloma treated with bortezomib as first-line therapy had an increased incidence of falls within the first 12 months after starting treatment. Our secondary aim was to assess the overall survival of patients who fell compared to those who did not among patients who lived more than 12 months after initiating treatment. Methods: We analyzed the SEER-Medicare database for all patients 65 years old or older diagnosed with multiple myeloma between 2007 and 2013 and were enrolled in fee-for-service Medicare part A, B and D plans. The patients' corresponding Medicare claims data were analyzed through 2014 for myeloma treatments, fall claims, and covariates of interest. The primary outcome was accidental falls (E880-E888) occurring between 14 days to 12 months after starting multiple myeloma treatment. First-line therapy was defined as any anti-myeloma treatment administered within 14 days of starting multiple myeloma treatment, with bortezomib treatment being the focal independent variable. Cox regression was performed to determine the relative risk of having a fall after controlling for other covariates. Patients who started bortezomib after first-line therapy were censored at time of bortezomib commencement. The survival analysis included only patients who survived more than 12 months of starting treatment to allow landmark analysis of falls in the first year. Results: Of 4,084 older adults with new multiple myeloma diagnoses undergoing first-line therapy, the median age was 75 (range 65-97) with 51% males. Bortezomib was used in first-line therapy for 2,052 (50%) patients, of which 157 (8%) patients experienced a fall within 12 months after starting treatment compared to 102 (5%) of patients not receiving bortezomib (p < 0.001). Bortezomib was associated with a 28% increase risk of falls (HR 1.29; 95% CI 1.00-1.65; p = 0.047). In multivariate analysis, bortezomib was not associated with an increased incidence of falls after controlling for age, gender, race, proxies for Charlson Comorbidity Index (CCI) and poor performance status, pre-existing peripheral neuropathy, falls within the 12 months prior to starting first-line myeloma treatment, depression, polypharmacy, and first-line treatment with lenalidomide (Table 1). Advancing age, history of fall(s), depression, and polypharmacy (defined as more than 10 unique prescription medications at initiation of first-line treatment), were all associated with an increased risk of falls, consistent with prior literature. In a landmark analysis of those who survived 12 months following the start of treatment, a fall was associated with a 26% increased risk of hazard for death (aHR 1.26; 95% CI 1.02-1.56; p = 0.033) after controlling for other covariates. The median OS of those with a fall was 35.7 months (95% CI 29.1-48.4) compared to 49.1 months (95% CI 47.1-52.8) for those without (p < 0.0001). Conclusion: In older adults with multiple myeloma, treatment with bortezomib was not associated with increased risk of a patient having a diagnostic code for falls. However, experiencing a fall within the year after starting treatment was associated with decreased overall survival. Limitations of the study include that the incidence of falls is likely underestimated in billing data, given prior data from our group showing a rate of self-reported falls of 26% in the year after diagnosis. Additional research, including prospective trials involving fall assessments, should be considered in older patients with multiple myeloma. Disclosures Wildes: Janssen: Research Funding; Carevive: Consultancy. Fiala:Incyte: Research Funding.

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Bendamustine Adversely Affects Stem Cell Mobilization Among Patients with Mantle Cell Lymphoma (MCL): A Comparison of the BR Vs RCHOP Eras in British Columbia (BC), Canada

Blood ◽

10.1182/blood-2018-99-114371 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 4556-4556

Author(s):

Hatem Alahwal ◽

Parv Chapani ◽

Diego Villa ◽

Yasser Abou Mourad ◽

Maryse Power ◽

...

Keyword(s):

Stem Cell ◽

Platelet Count ◽

Univariate Analysis ◽

First Line ◽

First Line Therapy ◽

Line Therapy ◽

Risk Of Failure ◽

Increased Risk ◽

Cd34 Cells ◽

Frontline Therapy

Abstract Introduction In 2013, bendamustine/rituximab (BR) replaced RCHOP as standard first line treatment for both transplant eligible and ineligible MCL patients (pts) in BC. Retrospective cohort studies report that bendamustine has no adverse effect on peripheral blood stem cell (SC) mobilization but this is discordant with local experience. We sought to compare rates of failed SC collection in MCL pts planned for high dose chemotherapy and autologous stem cell transplant (ASCT) after BR or RCHOP and identify risk factors for failed SC mobilization and collection. Methods We identified all pts with MCL in BC treated with BR or RCHOP as first line therapy who underwent SC mobilization from Jan. 1 2003-Dec. 31 2017 using the Leukemia/Bone Marrow Transplant Program of BC and Apheresis Database Standard mobilization was with G-CSF alone (G) until difficulties with SC collection were noted after BR. Different mobilization strategies were then used, including delaying SC collection 2-3 mos after BR, G + cyclophosphamide (G+C) mobilization and/or "rescue" plerixafor if Day 1 SC collection was inadequate. Failure of SC collection was defined as yield <1 x106 CD34+ cells/kg on apheresis Day 1 (D1fail). . All variables significant in univariate analysis (P<0.1) were entered into a multivariate analysis (MVA) logistic regression model to identify factors associated with D1 fail. Results A total of 152 pts were identified. 2 were excluded as they had pre-emptive plerixafor prior to apheresis D1 on a trial. Of the remaining 150 pts, 55 (37%) received BR, 95 (63%) RCHOP for a median of 6 cycles (range 1-6). Baseline characteristics were similar between groups (Table 1). Pts receiving BR had higher remission rates compared to RCHOP (CR 58% vs 35%, P=.004) and a longer duration from their last chemotherapy to apheresis D1 (BR 89 d vs RCHOP 39 d, P<0.), reflecting an intentional change in practice. For this same reason, use of G+C mobilization was higher in BR pts (45%) compared with RCHOP pts (1%). Failure on D1 of SC collection was significantly higher after BR compared to RCHOP (45% vs. 10%, P<.001). This difference persisted when only pts mobilized with G alone were included: D1fail 60% BR vs 10% RCHOP (P<.001), Fig. 1. Among BR pts, D1fail was higher for those mobilized with G compared with G+C (60% vs. 28%, P=.03). Of the 25 BR pts with D1fail, 20 pts received rescue plerixafor (P) (1 dose: 18, 2 doses: 1, 3 doses: 1) with 17 successfully collecting > 2.0 x106 CD34+ cells/kg, 2 successfully collected after a 2nd round of SC mobilization (Pt1: G+C+P, Pt2: G+P), and 1 pt did not undergo ASCT due to collection failure. Of the 5 pts who did not receive plerixafor, 2 successfully collected with 1-2 additional apheresis days and 3 successfully collected with a 2nd round of SC mobilization (2: G+P, 1: G+C). Among the 9 RCHOP pts with D1fail, 1 had rescue plerixafor with success, 3 successfully collected after 1-2 more apheresis days and 5 had a 2nd round of SC mobilization (1: G, 4: G+P), of which 1 failed and did not proceed to ASCT. Univariate analysis identified the following associated with D1fail: frontline therapy (BR vs RCHOP, P=<.001), mobilization regimen (G+C vs G, P=.001), gender (P=.002) and D1 platelet count (P=<.001). Delaying SC mobilization in pts who received BR did not improve D1 yield (P=.31). In MVA, frontline therapy with BR had an increased risk of D1fail compared to RCHOP with an odds ratio (OR) of 7.83 (95% CI 2.7-23.1), P<.001. Using G+C significantly improved the odds of a successful collection compared to G alone (OR for D1fail 0.17 [95% CI 0.05-0.62], P=.007). Female gender and low platelet count also increased risk of D1fail in MVA (Table 2). Conclusion MCL pts who receive BR as first line therapy have an almost 8-times higher risk of failure of D1 SC collection compared to those who receive RCHOP. This failure can be overcome largely with "rescue" plerixafor and partially with planned G+C mobilization such that successful collection can be achieved in >90% of pts. However, these agents add cost and potential toxicity. Platelet count on D1 SC collection is a potential indicator of high risk of failure. Delaying SC mobilization in BR pts does not improve collection yield. The impact of bendamustine in pre-transplant chemotherapy regimens, not only for MCL but also for a broad range of lymphomas where it is being increasingly used, must be considered when planning SC mobilization strategies. Disclosures Sehn: Karyopharm: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Lundbeck: Consultancy, Honoraria; Merck: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria; TG Therapeutics: Consultancy, Honoraria; Roche/Genentech: Consultancy, Honoraria; Seattle Genetics: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Morphosys: Consultancy, Honoraria; Celgene: Consultancy, Honoraria.

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Recurrent Priapism From Cabergoline and Bromocriptine in a Hypogonadal Man With Prolactinoma

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/23247096211029750 ◽

2021 ◽

Vol 9 ◽

pp. 232470962110297

Author(s):

Lakshmi P. Menon ◽

Wedad Rahman

Keyword(s):

Pituitary Adenoma ◽

Prolactin Level ◽

Side Effect ◽

Dopamine Agonists ◽

First Line ◽

Potential Side Effect ◽

First Line Therapy ◽

Line Therapy ◽

Rare Side Effect ◽

Recurrent Priapism

Dopamine agonists are generally well tolerated and represent the first-line therapy for prolactinomas. We report a case of a 20-year-old man with a macroprolactinoma who developed recurrent priapism with cabergoline and bromocriptine. Transsphenoidal pituitary adenoma resection was done with normalization of the prolactin level. Priapism is a rare side effect of dopamine agonists that warrants discontinuation of therapy. Patients should be educated about this potential side effect at the time of prescribing the medication.

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Thrombolysis for Trauma-Associated Inferior Vena Caval Thrombosis can be Safe in Selected Patients: A Case Report and Review of the Literature

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v3i2.85 ◽

2019 ◽

Vol 3 (2) ◽

Author(s):

Cara Swain ◽

Mladen Macanovic ◽

Robert Faulconer

Keyword(s):

Inferior Vena ◽

Traumatic Injury ◽

First Line ◽

Inferior Vena Caval ◽

First Line Therapy ◽

Percutaneous Catheter ◽

Line Therapy ◽

Catheter Directed Thrombolysis ◽

Increased Risk ◽

Inferior Vena Caval Thrombosis

Traumatic injury results in significant physiological changes that place patients at elevated risk for venous thromboembolism (VTE). Percutaneous catheter-directed thrombolysis has been recommended as a first-line therapy for treatment of VTE but is relatively contraindicated in trauma cases due to increased risk of bleeding. The authors present a case to support the opinion that thrombolysis for trauma-associated inferior vena caval thrombosis can be safe in selected patients, with discussion of existing literature.

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Statin use and risk of diabetes mellitus

Diabetes Mellitus ◽

10.14341/2072-0351-5523 ◽

2012 ◽

Vol 15 (2) ◽

pp. 77-82

Author(s):

Oksana Mikhailovna Drapkina ◽

Marina Viktorovna Kostyukevich

Keyword(s):

Diabetes Mellitus ◽

Combined Treatment ◽

Risk Groups ◽

First Line ◽

Bile Acid Sequestrants ◽

First Line Therapy ◽

Line Therapy ◽

Increased Risk ◽

Increase Risk

At present time four groups of medications are used to correct dyslipidemia: bile acid sequestrants, niacin, fibric acid derivatives andstatins. During last years statins' potential to increase risk of type 2 diabetes mellitus (T2DM) is actively discussed, though no commonopinion about the possible mechanism of such effect has evolved as yet. Insulin desensitizing effect as a class feature of statins remainsa disputable question.Position of statins as a first-line therapy for severe hyperlipidemia seems undoubted; however they do not improve insulin sensitivity.Moreover, several studies reported increased risk of T2DM. It is feasible to consider combined treatment (including metformin) inpatients from risk groups for development of T2DM, receiving statins

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First-Line Therapy for Immune Thrombocytopenia

Hämostaseologie ◽

10.1055/s-0039-1684031 ◽

2019 ◽

Vol 39 (03) ◽

pp. 259-265 ◽

Cited By ~ 2

Author(s):

Siraj Mithoowani ◽

Donald M. Arnold

Keyword(s):

Platelet Count ◽

Immune Thrombocytopenia ◽

Bleeding Complications ◽

High Dose ◽

First Line ◽

Risk Of Bleeding ◽

First Line Therapy ◽

Line Therapy ◽

Increased Risk ◽

Count Response

AbstractImmune thrombocytopenia (ITP) is an autoimmune disease affecting blood platelets that causes thrombocytopenia and an increased risk of bleeding. First-line therapy is indicated for patients with bleeding complications or who are at increased risk of bleeding, and the decision to initiate therapy depends not only on the platelet count, but also on other endpoints including quality of life. The choice of first-line therapy depends primarily on how quickly a platelet count response is required, with intravenous immune globulin providing the more rapid response, followed by high-dose dexamethasone and prednisone. In this narrative review, we discuss key issues with first-line therapy in ITP including when to initiate therapy, treatment options and special considerations for children. Evidence-based guidelines are lacking for the emergency management of patients with ITP who present with significant bleeding; we provide our approach to this critical situation.

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Review of the Treatment of Restless Legs Syndrome: Focus on Gabapentin Enacarbil

Journal of Central Nervous System Disease ◽

10.4137/jcnsd.s9107 ◽

2012 ◽

Vol 4 ◽

pp. JCNSD.S9107 ◽

Cited By ~ 4

Author(s):

Rachel A. Burke ◽

Michele A. Faulkner

Keyword(s):

Clinical Trials ◽

Restless Legs Syndrome ◽

Dopamine Agonists ◽

First Line ◽

Gabapentin Enacarbil ◽

Restless Legs ◽

First Line Therapy ◽

Line Therapy ◽

Dopaminergic Agent

The FDA approved gabapentin enacarbil in 2011 as the first non-dopaminergic agent for the treatment of restless legs syndrome (RLS) symptoms. Although gabapentin enacarbil is a pro-drug of gabapentin, its pharmacokinetics differ. Absorption of gabapentin enacarbil is more predictable, and inter-patient variability in bioavailability is lower than that of gabapentin. Studies have demonstrated superiority of gabapentin enacarbil compared to placebo. Comparisons to currently available RLS treatments are lacking, but clinical trials demonstrate comparable improvement in RLS symptoms to the dopamine agonists ropinirole and pramipexole, which are usually considered first-line therapy for daily RLS symptoms. Gabapentin enacarbil was well tolerated in clinical trials. The role of the drug in RLS treatment remains undefined, although it will likely be used as an alternative for refractory RLS when other treatments have failed. Additionally, gabapentin enacarbil may be recommended for patients with daily RLS symptoms that are less intense or are associated with pain as an alternative to dopamine agonists.

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