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

Viecceli, Camila / Mattos, Ana Carolina Viana / Hirakata, Vânia Naomi / Garcia, Sheila Piccoli / Rodrigues, Ticiana da Costa / Czepielewski, Mauro Antônio

Frontiers in endocrinology

2023 Volume 14, Page(s) 1145775

Abstract: 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 ... ...

Abstract	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. Systematic review registration: https://www.crd.york.ac.uk/prospero/#searchadvanced, (CRD42022308041).
MeSH term(s)	Humans ; Ketoconazole/therapeutic use ; Pituitary ACTH Hypersecretion/drug therapy ; Pituitary ACTH Hypersecretion/surgery ; Cushing Syndrome ; Hydrocortisone ; Prospective Studies ; Retrospective Studies
Chemical Substances	Ketoconazole (R9400W927I) ; Hydrocortisone (WI4X0X7BPJ)
Language	English
Publishing date	2023-05-08
Publishing country	Switzerland
Document type	Meta-Analysis ; Systematic Review ; Research Support, Non-U.S. Gov't
ZDB-ID	2592084-4
ISSN	1664-2392
ISSN	1664-2392
DOI	10.3389/fendo.2023.1145775
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Article: Evaluation of ketoconazole as a treatment for Cushing's disease in a retrospective cohort.

Viecceli, Camila / Mattos, Ana Carolina Viana / Costa, Maria Carolina Bittencourt / de Melo, Rafael Borba / Rodrigues, Ticiana da Costa / Czepielewski, Mauro Antonio

Frontiers in endocrinology

2022 Volume 13, Page(s) 1017331

Abstract: Objective: The first-line treatment for Cushing's disease is transsphenoidal surgery, after which the rates of remission are 60 to 80%, with long-term recurrence of 20 to 30%, even in those with real initial remission. Drug therapies are indicated for ... ...

Abstract	Objective: The first-line treatment for Cushing's disease is transsphenoidal surgery, after which the rates of remission are 60 to 80%, with long-term recurrence of 20 to 30%, even in those with real initial remission. Drug therapies are indicated for patients without initial remission or with surgical contraindications or recurrence, and ketoconazole is one of the main available therapies. The objective of this study was to evaluate the safety profile of and the treatment response to ketoconazole in Cushing's disease patients followed up at the endocrinology outpatient clinic of a Brazilian university hospital. Patients and methods: This was a retrospective cohort of Cushing's disease patients with active hypercortisolism who used ketoconazole at any stage of follow-up. Patients who were followed up for less than 7 days, who did not adhere to treatment, or who were lost to follow-up were excluded. Results: Of the 172 Cushing's disease patients who were followed up between 2004 and 2020, 38 received ketoconazole. However, complete data was only available for 33 of these patients. Of these, 26 (78%) underwent transsphenoidal surgery prior to using ketoconazole, five of whom (15%) had also undergone radiotherapy; seven used ketoconazole as a primary treatment. Ketoconazole use ranged from 14 days to 14.5 years. A total of 22 patients had a complete response (66%), three patients had a partial response (9%), and eight patients had no response to treatment (24%), including those who underwent radiotherapy while using ketoconazole. Patients whose hypercortisolism was controlled or partially controlled with ketoconazole had lower baseline 24-h urinary free cortisol levels than the uncontrolled group [times above the upper limit of normal: 0.62 (SD, 0.41) Conclusion: Ketoconazole effectively controlled hypercortisolism in 66% of Cushing's disease patients, being a relatively safe drug for those without remission after transsphenoidal surgery or whose symptoms must be controlled until a new definitive therapy is carried out. Hypokalemia is a frequent metabolic effect not yet described in other series, which should be monitored during treatment.
MeSH term(s)	Humans ; Pituitary ACTH Hypersecretion/complications ; Pituitary ACTH Hypersecretion/drug therapy ; Pituitary ACTH Hypersecretion/surgery ; Ketoconazole/therapeutic use ; Retrospective Studies ; Hydrocortisone ; Cabergoline ; Hypokalemia/drug therapy ; Cushing Syndrome/drug therapy
Chemical Substances	Ketoconazole (R9400W927I) ; Hydrocortisone (WI4X0X7BPJ) ; Cabergoline (LL60K9J05T)
Language	English
Publishing date	2022-10-07
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2592084-4
ISSN	1664-2392
ISSN	1664-2392
DOI	10.3389/fendo.2022.1017331
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Article ; Online: Metabolic effects of antihyperglycemic agents and mortality: meta-analysis of randomized controlled trials.

Rados, Dimitris Varvaki / Viecceli, Camila / Pinto, Lana Catani / Gerchman, Fernando / Leitão, Cristiane Bauermann / Gross, Jorge Luiz

Scientific reports

2020 Volume 10, Issue 1, Page(s) 12837

Abstract: The effects of antihyperglycemic medications on cardiovascular events and mortality are heterogeneous and their effects on intermediate factors might explain these differences. This systematic review explores the relationship between metabolic factors, ... ...

Abstract	The effects of antihyperglycemic medications on cardiovascular events and mortality are heterogeneous and their effects on intermediate factors might explain these differences. This systematic review explores the relationship between metabolic factors, mechanism of action, and mortality effects of antihyperglycemic medications in type 2 diabetes. Randomized trials assessing the effects of antihyperglycemic medications on all-cause or cardiovascular mortality in type 2 diabetes were included. Myocardial infarction, stroke, and heart failure were secondary outcomes. The effects of medications on HbA1c, severe hypoglycemia (SH), body weight, systolic blood pressure (SBP), and mechanism of action were evaluated. Meta-analyses and meta-regressions were performed grouping studies according to the above-cited factors. All-cause mortality was lower for medications that reduced HbA1c, SH, body weight, and SBP. Decreased cardiovascular mortality was associated with lower HbA1c, SH, SBP. Myocardial infarction and stroke were also associated with favorable metabolic profile. These findings were not confirmed in meta-regression models. Medications associated with lower SH, body weight and SBP had a lower risk of heart failure. In conclusion, medications with better metabolic profile were associated with reduced all-cause and cardiovascular mortality. These findings are based on indirect comparisons and must be applied cautiously.
MeSH term(s)	Body Weight ; Cardiovascular Diseases/etiology ; Cardiovascular Diseases/mortality ; Cardiovascular Diseases/prevention & control ; Cause of Death ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/drug therapy ; Diabetes Mellitus, Type 2/metabolism ; Diabetes Mellitus, Type 2/mortality ; Female ; Glycated Hemoglobin/metabolism ; Humans ; Hypoglycemic Agents/therapeutic use ; Male ; Randomized Controlled Trials as Topic ; Risk ; Systole
Chemical Substances	Glycated Hemoglobin A ; Hypoglycemic Agents ; hemoglobin A1c protein, human
Language	English
Publishing date	2020-07-30
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Systematic Review
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-020-69738-w
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Article ; Online: Interesting findings in the VALERIA trial.

Rosa, Eduardo M / Viecceli, Camila

Journal of hypertension

2009 Volume 27, Issue 4, Page(s) 902; author reply 902–3

MeSH term(s)	Albuminuria/drug therapy ; Antihypertensive Agents/administration & dosage ; Drug Therapy, Combination ; Humans ; Hypertension, Renal/drug therapy ; Lisinopril/administration & dosage ; Randomized Controlled Trials as Topic ; Tetrazoles/administration & dosage ; Valine/administration & dosage ; Valine/analogs & derivatives ; Valsartan
Chemical Substances	Antihypertensive Agents ; Tetrazoles ; Valsartan (80M03YXJ7I) ; Lisinopril (E7199S1YWR) ; Valine (HG18B9YRS7)
Language	English
Publishing date	2009-04
Publishing country	England
Document type	Comment ; Letter
ZDB-ID	605532-1
ISSN	1473-5598 ; 0263-6352 ; 0952-1178
ISSN (online)	1473-5598
ISSN	0263-6352 ; 0952-1178
DOI	10.1097/HJH.0b013e3283194106
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Article ; Online: Is it only inflammation or infection as well?

Rosa, Eduardo Maffini da / Viecceli, Camila / Tormen, William Cenci

Arquivos brasileiros de cardiologia

2010 Volume 95, Issue 3, Page(s) 416; author reply 416–7

MeSH term(s)	Acute Coronary Syndrome/etiology ; False Positive Reactions ; Humans ; Inflammation/complications
Language	English
Publishing date	2010-10-08
Publishing country	Brazil
Document type	Comment ; Letter
ZDB-ID	730261-7
ISSN	1678-4170 ; 0066-782X
ISSN (online)	1678-4170
ISSN	0066-782X
DOI	10.1590/s0066-782x2010001300020
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Article ; Online: Comments on an acute myocardial infarction study.

Tormen, William C / Maffini da Rosa, Eduardo / Viecceli, Camila

Heart (British Cardiac Society)

2010 Volume 96, Issue 21, Page(s) 1780

MeSH term(s)	Cardiovascular Agents/therapeutic use ; Confounding Factors (Epidemiology) ; Drug Therapy, Combination ; Humans ; Myocardial Infarction/drug therapy
Chemical Substances	Cardiovascular Agents
Language	English
Publishing date	2010-11
Publishing country	England
Document type	Comment ; Letter
ZDB-ID	1303417-0
ISSN	1468-201X ; 1355-6037
ISSN (online)	1468-201X
ISSN	1355-6037
DOI	10.1136/hrt.2010.205674
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Article ; Online: Controversial issues in the management of hyperprolactinemia and prolactinomas - An overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism.

Vilar, Lucio / Abucham, Julio / Albuquerque, José Luciano / Araujo, Luiz Antônio / Azevedo, Monalisa F / Boguszewski, Cesar Luiz / Casulari, Luiz Augusto / Cunha Neto, Malebranche B C / Czepielewski, Mauro A / Duarte, Felipe H G / Faria, Manuel Dos S / Gadelha, Monica R / Garmes, Heraldo M / Glezer, Andrea / Gurgel, Maria Helane / Jallad, Raquel S / Martins, Manoel / Miranda, Paulo A C / Montenegro, Renan M /

Musolino, Nina R C / Naves, Luciana A / Ribeiro-Oliveira Júnior, Antônio / Silva, Cíntia M S / Viecceli, Camila / Bronstein, Marcello D

Archives of endocrinology and metabolism

2019 Volume 62, Issue 2, Page(s) 236–263

Abstract: Prolactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology ... ...

Abstract	Prolactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology of hyperprolactinemia. Indeed, PRL levels > 250 ng/mL are highly suggestive of the presence of a prolactinoma. In contrast, most patients with stalk dysfunction, drug-induced hyperprolactinemia or systemic diseases present with PRL levels < 100 ng/mL. However, exceptions to these rules are not rare. On the other hand, among patients with macroprolactinomas (MACs), artificially low PRL levels may result from the so-called "hook effect". Patients harboring cystic MACs may also present with a mild PRL elevation. The screening for macroprolactin is mostly indicated for asymptomatic patients and those with apparent idiopathic hyperprolactinemia. Dopamine agonists (DAs) are the treatment of choice for prolactinomas, particularly cabergoline, which is more effective and better tolerated than bromocriptine. After 2 years of successful treatment, DA withdrawal should be considered in all cases of microprolactinomas and in selected cases of MACs. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) is to provide a review of the diagnosis and treatment of hyperprolactinemia and prolactinomas, emphasizing controversial issues regarding these topics. This review is based on data published in the literature and the authors' experience.
MeSH term(s)	Antineoplastic Agents/therapeutic use ; Brazil ; Bromocriptine/therapeutic use ; Cabergoline ; Dopamine Agonists/therapeutic use ; Ergolines/therapeutic use ; Female ; Humans ; Hyperprolactinemia/diagnosis ; Hyperprolactinemia/therapy ; Male ; Pituitary Neoplasms/diagnosis ; Pituitary Neoplasms/therapy ; Practice Guidelines as Topic ; Prolactin/blood ; Prolactinoma/diagnosis ; Prolactinoma/therapy
Chemical Substances	Antineoplastic Agents ; Dopamine Agonists ; Ergolines ; Bromocriptine (3A64E3G5ZO) ; Prolactin (9002-62-4) ; Cabergoline (LL60K9J05T)
Language	English
Publishing date	2019-04-01
Publishing country	Brazil
Document type	Journal Article ; Review
ISSN	2359-4292
ISSN (online)	2359-4292
DOI	10.20945/2359-3997000000032
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Article: Ketoconazole as second-line treatment for Cushing's disease after transsphenoidal surgery: systematic review and meta-analysis.

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Article: Evaluation of ketoconazole as a treatment for Cushing's disease in a retrospective cohort.

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Article ; Online: Metabolic effects of antihyperglycemic agents and mortality: meta-analysis of randomized controlled trials.

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Article ; Online: Interesting findings in the VALERIA trial.

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In stock of ZB MED Cologne/Königswinter

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Article ; Online: Is it only inflammation or infection as well?

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In stock of ZB MED Cologne/Königswinter

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Article ; Online: Comments on an acute myocardial infarction study.

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In stock of ZB MED Cologne/Königswinter

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Article ; Online: Controversial issues in the management of hyperprolactinemia and prolactinomas - An overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism.

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