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Thread: Cabergoline, Retinoic Acid, and other novel pituitary Cushing's treatments

  1. #1
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    Default Cabergoline, Retinoic Acid, and other novel pituitary Cushing's treatments

    Within the past year, we have been very interested to read about the experimental use of a new generation of medications that are aimed at treating the root cause of pituitary Cushing's, rather than merely controlling symptoms alone. Here are two related articles published by noted endocrinologist, Dr. David Bruyette:

    http://veterinarynews.dvm360.com/new...ork-root-cause

    http://www.k9cushings.com/forum/atta...1&d=1464966731

    As you'll see from Dr. Bruyette's summaries, many of the drug possibilities are still in experimental trials with humans, and have not been tested at all in dogs. We've also learned from talking to him directly that the extremely high cost of some of the possibilities will render them generally unavailable to the average owner at this time. One such example is retinoic acid, which thus far has been most widely tested in South America. However, one of our members has made contact with both the lead investigator in Argentina (as well as a pharmacy there), and reports that it may be possible to import retinoic acid. He has not yet attempted to do so yet, but here is his thread for folks who may be interested in learning more:

    Has anyone treated with 9-cis Retinoic Acid?

    Right now, it seems as though cabergoline is the experimental alternative that would be the most accessible option for canine pituitary patients in the U.S. It is readily available from general human pharmacies, although I am not certain about the cost. The big benefit of cabergoline is that it appears to have the ability to actually shrink enlarging pituitary tumors in addition to controlling symptoms. The downside is that only certain tumors seem to be receptive. In the studies thus far, 40% of the dogs responded, most generally when their tumors were located in the pars intermedia area of the pituitary gland.

    We have had at least one member, though, who reports cabergoline treatment success overseen by Dr. Bruyette himself. We also have a couple of other members who are now considering the treatment for their dogs, as well. For that reason, we are especially interested in starting this thread so that they -- and anyone else -- can tell us more about their experiences with any of these novel treatments.

    Marianne

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    Default Re: Skippy, 12 y/o Yorkie with likely pituitary tumor (Trilostane)

    In case it hasn't already been posted, here is the original text of Castillo's study on Retinoic Acid. I know others have explored the availability of this drug without success. I saw a few studies suggesting it may have efficacy with humans as well.

    https://academic.oup.com/endo/articl...0/en.2006-0414


    Here is an overview of drugs that are being tested.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2840568/

    One more study on retinoic acid which is also called Isotretinoin and is available commercially for approximately $280.00 a month or less depending on strength. This study mentions the Castillo study.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4789464/

    I wish I had medical education or this stuff was less technical!

    ______________________________
    (Administrative Note: Carole, I 've made a copy of this reply you had earlier posted on Skippy's thread and placed it here, as well.)
    Last edited by labblab; 04-23-2017 at 07:23 AM. Reason: To add note.
    Skippy's Mom

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    Default Re: Cabergoline and other novel pituitary Cushing's treatments

    Marianne,

    I just read your thread on Cabergoline where you mentioned Retinoic Acid. I just read a couple of articles and posted one where they called this drug "Isotretinoin" and also by another name starting with "T". If I am dumb wrong about the drug's various names please let me know and I will delete the reference from my post. Isotretinoin is available commercially for $250 to $280 for 30 pills.

    From the link below, "isotretinoin, a 13-cis-isomer of retinoic acid [32],"

    https://www.hindawi.com/journals/ije/2016/8173182/
    Last edited by Carole Alexander; 04-22-2017 at 05:18 PM. Reason: Add Link
    Skippy's Mom

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    Default Re: Cabergoline and other novel pituitary Cushing's treatments

    Hi Carole, you'll see I went ahead and placed a copy here of the earlier reply you were talking about. I think it's very helpful to have all those links here, too.

    I wish I could tell you I know anything about retinoic acid, but unfortunately I do not . One confusing thing I've noticed is that there appear to be different "forms" of RA, and that 9-cis RA (Alitretinoin) seems to have been used in the canine study, while 13-cis RA (Isotretinoin) was used in the human study.

    I think 13-cis RA has also been used most commonly in humans to treat acne. But that's where my knowledge ends. Whether the form affects the efficacy, pricing, and availability of the RA here in the U.S., I simply do not know. I'm thinking that it does, though, since our member (who started the thread cited in my first post here) was earlier trying to find ways to import from Argentina the form of the drug that was used so effectively in the South American canine study -- the 9-cis version. Therefore, it must not be readily available or affordable here in the U.S.

    Hopefully somebody with more knowledge about all of this will stop by at some point!

    Marianne

    P.S. I've just now edited our thread title to specifically name retinoic acid; hopefully, this will make it more likely that somebody with experience or knowledge will stop by.

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    Default Re: Cabergoline, Retinoic Acid, and other novel pituitary Cushing's treatments

    This is extremely interesting.
    Judi & "mah boy" Keesh

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    Default Re: Cabergoline, Retinoic Acid, and other novel pituitary Cushing's treatments

    Before my computer had to go in for repair because the cursor keeps freezing, I found a couple of articles reporting research on Cabergoline that I had not previously seen. (And, I thought I had searched pretty exhaustively.) I will post both soon, but one question raised is dose strength. With the humans in the one study, they increased the dose over time. Skippy is on a tiny dose, .05 every other day; I wonder about increasing the dose? I will post more soon.
    Skippy's Mom

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    Default Re: Cabergoline, Retinoic Acid, and other novel pituitary Cushing's treatments

    Folks: I came across a 2016 article by Dr. Bruyette that includes both the traditional and investigative drugs, some of which have been mentioned and a couple of others that I had not heard of before. Here is the link:

    https://media.wix.com/ugd/38e433_2a5...1d9fd721cd.pdf
    Judy H. (Always "Maggie's Mom" & now "Abbie's Mom")
    Riverview, FL

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    Default Re: Cabergoline, Retinoic Acid, and other novel pituitary Cushing's treatments

    Hey Judy, this same article is the second link in my first post here. But I'm glad you reposted it as a pdf, because my link is to an attachment and I just discovered that non-members are unable to view my link (I just clicked on it myself without having logged in). So I am very glad you've reposted it in a more widely accessible form.

    Marianne

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    Default Re: Cabergoline, Retinoic Acid, and other novel pituitary Cushing's treatments

    I found these two articles listing other alternate medications not previously mentioned; the Table below is "Summary of pharmacologic therapies for Cushing’s disease" taken from the "Pituitary-Directed Therapies for Cushing’s Disease" article.

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