Ketoconazole as second-line treatment for Cushing’s disease after transsphenoidal surgery : systematic review and meta-analysis

Detalhes bibliográficos
Autor(a) principal: Viecceli, Camila
Data de Publicação: 2023
Outros Autores: Mattos, Ana Carolina Viana, Hirakata, Vania Naomi, Garcia, Sheila Piccoli, Rodrigues, Ticiana da Costa, Czepielewski, Mauro Antonio
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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spelling 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.
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dc.relation.ispartof.pt_BR.fl_str_mv Frontiers in endocrinology. Lausanne. Vol. 14 (2023), 1145775, 8 p.
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