Metabolic effects of dopamine agonists in patients with prolactinomas: a systematic review and meta-analysis

Objectives: Recent large cohort studies suggest an association between high plasma prolactin and cardiovascular mortality. The objective of this systematic review was to systematically assess the effect of reducing prolactin with dopamine agonist on established cardiovascular risk factors in patients with prolactinomas. Design: Bibliographical search was done until February 2019 searching the following databases: PubMed, EM BASE, WHO and LILAC. Eligible studies had to include participants with verified prolactinomas where metabolic variables were assessed before and after at least 2 weeks treatment with dopamine agonists. Methods: Baseline data and outcomes were independently collected by two investigators. The study was registered with PROSPERO (registration number CRD42016046525). Results: Fourteen observational studies enrolling 387 participants were included. The pooled standardized mean difference of the primary outcome revealed a reduction of BMI and weight of -0.21 (95% CI -0.37 to -0.05; P = 0.01; I-2 = 71%), after treatment. Subgroup analysis suggested that the reduction of weight was primarily driven by studies with high prolactin levels at baseline (P = 0.04). Secondary outcomes suggested a small decrease in waist circumference, a small-to-moderate decrease in triglycerides, fasting glucose levels, HOMA-IR, HbA1c and h5CRP, and a moderate decrease in LDL, total cholesterol and insulin. Conclusion: This systematic review suggests a reduction of weight as well as an improved lipid profile and glucose tolerance after treatment with dopamine agonist in patients with prolactinomas. These data are based on low-quality evidence.