Ketoconazole as second-line treatment for Cushing’s disease after transsphenoidal surgery : systematic review and meta-analysis
Autor(a) principal: | |
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Data de Publicação: | 2023 |
Outros Autores: | , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFRGS |
Texto Completo: | http://hdl.handle.net/10183/276417 |
Resumo: | Introduction: The first-line treatment for Cushing’s disease is transsphenoidal surgery for pituitary tumor resection. Ketoconazole has been used as a second-line drug despite limited data on its safety and efficacy for this purpose. The objective of this meta-analysis was to analyze hypercortisolism control in patients who used ketoconazole as a second-line treatment after transsphenoidal surgery, in addition to other clinical and laboratory criteria that could be related to therapeutic response. Methods: We searched for articles that evaluated ketoconazole use in Cushing’s disease after transsphenoidal surgery. The search strategies were applied to MEDLINE, EMBASE, and SciELO. Independent reviewers assessed study eligibility and quality and extracted data on hypercortisolism control and related variables such as therapeutic dose, time, and urinary cortisol levels. Results: After applying the exclusion criteria, 10 articles (one prospective and nine retrospective studies, totaling 270 patients) were included for complete data analysis. We found no publication bias regarding reported biochemical control or no biochemical control (p = 0.06 and p = 0.42 respectively). Of 270 patients, biochemical control of hypercortisolism occurred in 151 (63%, 95% CI 50-74%) and no biochemical control occurred in 61 (20%, 95% CI 10-35%). According to the meta-regression, neither the final dose, treatment duration, nor initial serum cortisol levels were associated with biochemical control of hypercortisolism. Conclusion: Ketoconazole can be considered a safe and efficacious option for Cushing’s disease treatment after pituitary surgery. |
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Viecceli, CamilaMattos, Ana Carolina VianaHirakata, Vania NaomiGarcia, Sheila PiccoliRodrigues, Ticiana da CostaCzepielewski, Mauro Antonio2024-07-17T05:37:29Z20231664-2392http://hdl.handle.net/10183/276417001198001Introduction: The first-line treatment for Cushing’s disease is transsphenoidal surgery for pituitary tumor resection. Ketoconazole has been used as a second-line drug despite limited data on its safety and efficacy for this purpose. The objective of this meta-analysis was to analyze hypercortisolism control in patients who used ketoconazole as a second-line treatment after transsphenoidal surgery, in addition to other clinical and laboratory criteria that could be related to therapeutic response. Methods: We searched for articles that evaluated ketoconazole use in Cushing’s disease after transsphenoidal surgery. The search strategies were applied to MEDLINE, EMBASE, and SciELO. Independent reviewers assessed study eligibility and quality and extracted data on hypercortisolism control and related variables such as therapeutic dose, time, and urinary cortisol levels. Results: After applying the exclusion criteria, 10 articles (one prospective and nine retrospective studies, totaling 270 patients) were included for complete data analysis. We found no publication bias regarding reported biochemical control or no biochemical control (p = 0.06 and p = 0.42 respectively). Of 270 patients, biochemical control of hypercortisolism occurred in 151 (63%, 95% CI 50-74%) and no biochemical control occurred in 61 (20%, 95% CI 10-35%). According to the meta-regression, neither the final dose, treatment duration, nor initial serum cortisol levels were associated with biochemical control of hypercortisolism. Conclusion: Ketoconazole can be considered a safe and efficacious option for Cushing’s disease treatment after pituitary surgery.application/pdfengFrontiers in endocrinology. Lausanne. Vol. 14 (2023), 1145775, 8 p.CetoconazolHipersecreção hipofisária de ACTHTerapêuticaRevisão sistemáticaMetanáliseKetoconazoleCushing’s diseaseTreatmentSystematic reviewMeta-analysisKetoconazole as second-line treatment for Cushing’s disease after transsphenoidal surgery : systematic review and meta-analysisEstrangeiroinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFRGSinstname:Universidade Federal do Rio Grande do Sul (UFRGS)instacron:UFRGSTEXT001198001.pdf.txt001198001.pdf.txtExtracted Texttext/plain38906http://www.lume.ufrgs.br/bitstream/10183/276417/5/001198001.pdf.txt2ecd63fb7e32c93d9df450545a4bf3edMD55001198001-02.pdf.txt001198001-02.pdf.txtExtracted Texttext/plain600http://www.lume.ufrgs.br/bitstream/10183/276417/6/001198001-02.pdf.txt6d6628dd8a6c3e175370c737eb6f33d8MD56001198001-03.pdf.txt001198001-03.pdf.txtExtracted Texttext/plain621http://www.lume.ufrgs.br/bitstream/10183/276417/7/001198001-03.pdf.txt80634ebf41e33d2f1ffc0e8953cc3d48MD57001198001-04.pdf.txt001198001-04.pdf.txtExtracted Texttext/plain2585http://www.lume.ufrgs.br/bitstream/10183/276417/8/001198001-04.pdf.txt161efc31e3c801cc5972d7d8d15b3141MD58ORIGINAL001198001.pdfTexto completo (inglês)application/pdf1218872http://www.lume.ufrgs.br/bitstream/10183/276417/1/001198001.pdf76520faa726dd67fde13241910bfc792MD51001198001-02.pdfMaterial suplementarapplication/pdf17419http://www.lume.ufrgs.br/bitstream/10183/276417/2/001198001-02.pdf233e09758be94cf2c73c8181c572d75fMD52001198001-03.pdfMaterial suplementarapplication/pdf17566http://www.lume.ufrgs.br/bitstream/10183/276417/3/001198001-03.pdf97f7a1f6390549f25932acf30f5dd464MD53001198001-04.pdfMaterial suplementarapplication/pdf105186http://www.lume.ufrgs.br/bitstream/10183/276417/4/001198001-04.pdfef800747eacfad861141c378f2bb8bf9MD5410183/2764172024-07-18 06:15:50.671615oai:www.lume.ufrgs.br:10183/276417Repositório de PublicaçõesPUBhttps://lume.ufrgs.br/oai/requestopendoar:2024-07-18T09:15:50Repositório Institucional da UFRGS - Universidade Federal do Rio Grande do Sul (UFRGS)false |
dc.title.pt_BR.fl_str_mv |
Ketoconazole as second-line treatment for Cushing’s disease after transsphenoidal surgery : systematic review and meta-analysis |
title |
Ketoconazole as second-line treatment for Cushing’s disease after transsphenoidal surgery : systematic review and meta-analysis |
spellingShingle |
Ketoconazole as second-line treatment for Cushing’s disease after transsphenoidal surgery : systematic review and meta-analysis Viecceli, Camila Cetoconazol Hipersecreção hipofisária de ACTH Terapêutica Revisão sistemática Metanálise Ketoconazole Cushing’s disease Treatment Systematic review Meta-analysis |
title_short |
Ketoconazole as second-line treatment for Cushing’s disease after transsphenoidal surgery : systematic review and meta-analysis |
title_full |
Ketoconazole as second-line treatment for Cushing’s disease after transsphenoidal surgery : systematic review and meta-analysis |
title_fullStr |
Ketoconazole as second-line treatment for Cushing’s disease after transsphenoidal surgery : systematic review and meta-analysis |
title_full_unstemmed |
Ketoconazole as second-line treatment for Cushing’s disease after transsphenoidal surgery : systematic review and meta-analysis |
title_sort |
Ketoconazole as second-line treatment for Cushing’s disease after transsphenoidal surgery : systematic review and meta-analysis |
author |
Viecceli, Camila |
author_facet |
Viecceli, Camila Mattos, Ana Carolina Viana Hirakata, Vania Naomi Garcia, Sheila Piccoli Rodrigues, Ticiana da Costa Czepielewski, Mauro Antonio |
author_role |
author |
author2 |
Mattos, Ana Carolina Viana Hirakata, Vania Naomi Garcia, Sheila Piccoli Rodrigues, Ticiana da Costa Czepielewski, Mauro Antonio |
author2_role |
author author author author author |
dc.contributor.author.fl_str_mv |
Viecceli, Camila Mattos, Ana Carolina Viana Hirakata, Vania Naomi Garcia, Sheila Piccoli Rodrigues, Ticiana da Costa Czepielewski, Mauro Antonio |
dc.subject.por.fl_str_mv |
Cetoconazol Hipersecreção hipofisária de ACTH Terapêutica Revisão sistemática Metanálise |
topic |
Cetoconazol Hipersecreção hipofisária de ACTH Terapêutica Revisão sistemática Metanálise Ketoconazole Cushing’s disease Treatment Systematic review Meta-analysis |
dc.subject.eng.fl_str_mv |
Ketoconazole Cushing’s disease Treatment Systematic review Meta-analysis |
description |
Introduction: The first-line treatment for Cushing’s disease is transsphenoidal surgery for pituitary tumor resection. Ketoconazole has been used as a second-line drug despite limited data on its safety and efficacy for this purpose. The objective of this meta-analysis was to analyze hypercortisolism control in patients who used ketoconazole as a second-line treatment after transsphenoidal surgery, in addition to other clinical and laboratory criteria that could be related to therapeutic response. Methods: We searched for articles that evaluated ketoconazole use in Cushing’s disease after transsphenoidal surgery. The search strategies were applied to MEDLINE, EMBASE, and SciELO. Independent reviewers assessed study eligibility and quality and extracted data on hypercortisolism control and related variables such as therapeutic dose, time, and urinary cortisol levels. Results: After applying the exclusion criteria, 10 articles (one prospective and nine retrospective studies, totaling 270 patients) were included for complete data analysis. We found no publication bias regarding reported biochemical control or no biochemical control (p = 0.06 and p = 0.42 respectively). Of 270 patients, biochemical control of hypercortisolism occurred in 151 (63%, 95% CI 50-74%) and no biochemical control occurred in 61 (20%, 95% CI 10-35%). According to the meta-regression, neither the final dose, treatment duration, nor initial serum cortisol levels were associated with biochemical control of hypercortisolism. Conclusion: Ketoconazole can be considered a safe and efficacious option for Cushing’s disease treatment after pituitary surgery. |
publishDate |
2023 |
dc.date.issued.fl_str_mv |
2023 |
dc.date.accessioned.fl_str_mv |
2024-07-17T05:37:29Z |
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Estrangeiro info:eu-repo/semantics/article |
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http://hdl.handle.net/10183/276417 |
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1664-2392 |
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001198001 |
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http://hdl.handle.net/10183/276417 |
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eng |
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Frontiers in endocrinology. Lausanne. Vol. 14 (2023), 1145775, 8 p. |
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