Successful Disease Control Research Articles

Dramatic Effect of Tofacitinib on TNF-Inhibitor Resistant Synovitis: A Case Report

A 58-year-old woman with a 2.5-year history of rheumatoid arthritis showed a pain, severe swelling, and a decreased range of motion of left knee joint. Medical therapy with 8 mg per week of oral methotrexate and 1 mg per day of tacrolimus in combination with 40 mg per 2 weeks of adalimumab failed to control the disease activity. Administration of tofacitinib achieved the successful disease control, and MRI taken 5 months after the initiation of tofacitinib showed the disappearance of synovial mass within the knee joint and the bone marrow oedema and marked reduction of the popliteal cyst. The use of tofacitinib for inadequate response to the first TNF inhibitor as a third-line DMARD showed dramatic effect on severe synovitis, and the patient could avoid the surgical intervention.

Controlling of CSFV in European wild boar using oral vaccination: a review.

Classical swine fever (CSF) is among the most detrimental diseases for the swine industry worldwide. Infected wild boar populations can play a crucial role in CSF epidemiology and controlling wild reservoirs is of utmost importance for preventing domestic outbreaks. Oral mass vaccination (OMV) has been implemented to control CSF in wild boars and limit the spill over to domestic pigs. This retrospective overview of vaccination experiences illustrates the potential for that option. The C-strain live vaccine was confirmed to be highly efficacious and palatable baits were developed for oral delivery in free ranging wild boars. The first field trials were performed in Germany in the 1990’s and allowed deploying oral baits at a large scale. The delivery process was further improved during the 2000’s among different European countries. Optimal deployment has to be early regarding disease emergence and correctly designed regarding the landscape structure and the natural food sources that can compete with oral baits. OMV deployment is also highly dependent on a local veterinary support working closely with hunters, wildlife and forestry agencies. Vaccination has been the most efficient strategy for CSF control in free ranging wild boar when vaccination is wide spread and lasting for a sufficient period of time. Alternative disease control strategies such as intensified hunting or creating physical boundaries such as fences have been, in contrast, seldom satisfactory and reliable. However, monitoring outbreaks has been challenging during and after vaccination deployment since OMV results in a low probability to detect virus-positive animals and the live-vaccine currently available does not allow serological differentiation of infected from vaccinated animals. The development of a new marker vaccine and companion test is thus a promising option for better monitoring outbreaks during OMV deployment as well as help to better determine when to stop vaccination efforts. After rabies in red fox, the use of OMV against CSF in European wild boar can be considered as a second example of successful disease control in wildlife. The 30 years of disease control experience included in this review may provide options for improving future disease management within wild populations.

Abstract A18: A systems biology approach to predict immunotherapy augmented abscopal effects

Abstract Introduction and Objectives: Radiation-induced abscopal effects are characterized by regression of tumor nodules outside the local radiation treatment field. Abscopal effects have been reported in metastatic lymphoma, melanoma, lung and breast cancer as well as renal cell carcinoma amongst others. Radiotherapy causes a perturbation to the local immune profile that is propagated throughout the lymphatic system, shifting systemic immune surveillance towards tumor eradication in distant, non-irradiated sites as well as circulating micrometastases. We hypothesize that abscopal effects could be triggered by targeting combined radiation and immunotherapy to immunogenic hubs in the patient-specific interconnected metastatic-lymphatic network. Materials and Methods: We develop a mathematical model of the systemic response to local radio-immunotherapy. Patient-specific positron emission tomography (PET) scans provide the size and location of each tumor nodule. Metastatic geography is mapped onto the lymphatic network and connections between metastatic sites and lymphatic nodes are calculated. We quantify immune signal flow through the lymphatic network and amplifications through metastatic sites. A local model describes the temporal coevolution of tumor size with effector and regulatory T cells. The local and global models are coupled to quantify systemic responses to local treatment of each tumor site. Results: The ‘virtual patient’ framework successfully simulates the abscopal effect reported for 2 patients with widely metastatic melanoma and non-small cell lung cancer. Model simulations suggest that only one or two tumor nodules in each patient serve as immunogenic hubs that could trigger an abscopal response. Radio-immunotherapy of any other lesion would result in local tumor control but systemic disease progression. Conclusions: Careful selection of immunogenic ‘hub’ nodules holds the key to successful abscopal disease control. The presented mathematical framework may help to identify the immunogenicity of each tumor nodule. Before serving as a novel decision support tool, rigorous calibration and validation remains to be pursued as more clinical abscopal data becomes available. Citation Format: Jan Poleszczuk, Sotiris Prokopiou, Mark Robertson-Tessi, Kimberly Luddy, Eduardo Moros, Mayer Fishman, Julie Djeu, Heiko Enderling. A systems biology approach to predict immunotherapy augmented abscopal effects. [abstract]. In: Proceedings of the AACR Special Conference: Tumor Immunology and Immunotherapy: A New Chapter; December 1-4, 2014; Orlando, FL. Philadelphia (PA): AACR; Cancer Immunol Res 2015;3(10 Suppl):Abstract nr A18.

English

This study was conducted to determine the awareness, knowledge and practices of pastoralists on contagious bovine pleuropneumonia (CBPP) in cattle in 3 selected Local Government Areas (LGAs) (Ikara, Chikun and Kauru) of Kaduna State. A cattle population of a minimum of 20 heads was considered as a herd in this study and a total of 90 open and close ended structured questionnaires were designed and administered to all the 90 herdsmen that gave their consent for this study. The study revealed that, the level of awareness of CBPP by the pastoralists was 80 (88.9%) and formal education of 11 (12.2%), while knowledge of CBPP in the communities showed 66 (73.3%). Those that experienced outbreaks, as well as lost animals to CBPP, were 25 (27.8%) and 17 (18.9%), respectively. Of the respondents, 67 (74.4%) admitted vaccinating their cattle at various times, which is not regular, thereby achieving a  low vaccination coverage of 36.7%, while, 23 (25.5%) do not vaccinate at all. Fourty-six (51.1%) acquired the CBPP vaccines from the National Veterinary Research Institute (NVRI), Vom, Plateau State, while, 21 (23.3%) from the open market. Personnel used in the administration of vaccine were; Veterinarians 14 (15.6%), animal health workers 18(20%), drug vendors 18 (20%) and herdsmen 40 (44.4%). The study has shown that most pastoralists within the study area are aware of CBPP and have good knowledge of the disease. However, unethical practices such as sourcing and indiscriminate administering of vaccines as well as irregular vaccination schedule may hamper successful disease control. Pastoralists should be encouraged to intensify the pursuit for formal education.   Key words: Mycoplasma mycoides subsp. mycoides, awareness, knowledge, practices, pastoralists.

Awareness, knowledge and practices of pastoralists towards contagious bovine pleuro pneumonia in Kaduna State, Nigeria

This study was conducted to determine the awareness, knowledge and practices of pastoralists on contagious bovine pleuropneumonia (CBPP) in cattle in 3 selected Local Government Areas (LGAs) (Ikara, Chikun and Kauru) of Kaduna State. A cattle population of a minimum of 20 heads was considered as a herd in this study and a total of 90 open and close ended structured questionnaires were designed and administered to all the 90 herdsmen that gave their consent for this study. The study revealed that, the level of awareness of CBPP by the pastoralists was 80 (88.9%) and formal education of 11 (12.2%), while knowledge of CBPP in the communities showed 66 (73.3%). Those that experienced outbreaks, as well as lost animals to CBPP, were 25 (27.8%) and 17 (18.9%), respectively. Of the respondents, 67 (74.4%) admitted vaccinating their cattle at various times, which is not regular, thereby achieving a low vaccination coverage of 36.7%, while, 23 (25.5%) do not vaccinate at all. Fourty-six (51.1%) acquired the CBPP vaccines from the National Veterinary Research Institute (NVRI), Vom, Plateau State, while, 21 (23.3%) from the open market. Personnel used in the administration of vaccine were; Veterinarians 14 (15.6%), animal health workers 18(20%), drug vendors 18 (20%) and herdsmen 40 (44.4%). The study has shown that most pastoralists within the study area are aware of CBPP and have good knowledge of the disease. However, unethical practices such as sourcing and indiscriminate administering of vaccines as well as irregular vaccination schedule may hamper successful disease control. Pastoralists should be encouraged to intensify the pursuit for formal education. Key words: Mycoplasma mycoides subsp. mycoides, awareness, knowledge, practices, pastoralists.

The Promise of Preventive Cancer Vaccines.

Years of unsuccessful attempts at fighting established tumors with vaccines have taught us all that they are only able to truly impact patient survival when used in a preventive setting, as would normally be the case for traditional vaccines against infectious diseases. While true primary cancer prevention is still but a long-term goal, secondary and tertiary prevention are already in the clinic and providing encouraging results. A combination of immunopreventive cancer strategies and recently approved checkpoint inhibitors is a further promise of forthcoming successful cancer disease control, but prevention will require a considerable reduction of currently reported toxicities. These considerations summed with the increased understanding of tumor antigens allow space for an optimistic view of the future.

Diseases, dilemmas, decisions—Converting epidemiological dilemmas into successful disease control decisions

This paper describes 50 years of personal experience in dealing with a range of animal and zoonotic diseases at national and global level, using a series of selected examples to illustrate both the nature of the various dilemmas and difficulties faced, and the way in which they were solved using the tools and techniques that were available at the particular time. A major theme throughout has been the dependence on advancing computer technology, which initially allowed only simple analyses and modelling activities to be undertaken, but as computers have grown increasingly powerful, techniques such as Bayesian spatial regression have become available to the epidemiologist, making possible forms of analysis and disease modelling which had been mere dreams in earlier decades.There is now a need to integrate these tools and techniques into a toolbox which allows both epidemiological and economic analysis to be applied to virtually any type of disease, thereby further extending the capacity of epidemiologists to solve even more difficult problems in the future.

Eficiência de fungicidas no controle do mofo branco na cultura da soja

Among the diseases that affect soybeans, white mold stands out as one of the most important currently. Chemical control has been the most effective, given the fast disease evolution and requires farmers’ close attention, primarily in relation to the time of the product being applied, this being one of the most important factors for successful disease control. Thus, this study aimed to evaluate the effectiveness of the control of white mold by applying foliar fungicides in different reproductive stages, by analyzing the progress of the disease in soybean pathosystem versus Sclerotinia sclerotiorum. The experimental area presents a crop rotation system with soybean and cotton being adopted for over 10 years and with a history of occurrence of white mold. Four treatments (Witness, Cercobin, Sumilex and Frowncide) in a randomized block design with four replications. We evaluated the incidence and disease severity in stages R5.1, R5.3 and R5.5. At the end of the experiment, the weight of sclerotia and yield were evaluated. Treatments were applied at four times every ten days from the beginning of flowering. Data were submitted to analysis of variance by F test and the means were compared by Tukey test at 5% probability. The fungicides showed efficiency in relation to the variables studied, with exception of the incidence of disease severity. The most effective fungicide against the significant gain in productivity was Frowncide. Chemical control significantly reduced the severity of the disease.

IMPACT OF BACTERIAL QUORUM SENSING SYSTEM ON CHANGES OF ORGANOLEPTIC MARKERS OF STORAGE CABBAGE

The regulation of phenotypes of vegetable-associated bacteria can be mediated through the production of acylated homoserine lactones (AHLs). This knowledge is essential for successful control of bacterial diseases of vegetable. The purpose of these investigations was to define the AHL patterns of gram-negative bacteria presented in storage cabbage by LC/MS technique. The phenomenon of regulating the pectinolytic activity and the exopolysaccharide (EPS) production by AHLs that are associated with microbial spoilage of cabbage was also examined. Among 100 strains isolated from storage cabbage, 47 isolates produced AHLs. The results of the 16S rDNA sequence analysis indicated that selected microflora was highly closely related to Pantoea agglomerans, Rahnella aquatilis, Pseudomonas fluorescens, Pseudomonas syringae, and Pseudomonas cedrina (approximately 98%-99% confidence). The chemical nature of AHLs produced by selected microflora differ from species to species. The pattern of AHLs of Ps. cedrina consisting of C8-HSL, 3-oxo-C10-HSL, and 3-hydroxy-C14-HSL, has not been previously reported. The present study demonstrates that bacterial spoilage of storage cabbage is influenced by quorum sensing. Application of furanone C-30 that acts as quorum sensing inhibitor, caused the significant reduction in the production of EPS and pectinolytic enzymes by examined bacteria.

The Cleveland Clinic Experience With Primary Central Nervous System Lymphoma

The rarity and difficulty of conducting large trials limit the evaluation of various treatment options for primary central nervous system lymphoma (PCNSL). In this study, we sought to describe the demographics, diagnoses, management, and outcomes of patients with PCNSL at a single institution. This is a retrospective study of 153 patients with PCNSL between 1986 and 2010. Prognostic factors identified by univariate and multivariable survival analyses were used by recursive partitioning analysis to generate a prognostic model. The median age was 61 and Karnofsky performance status (KPS) was 70. The progression-free survival was 9.3 months; the overall survival was 27 months. The diagnosis of PCNSL was established mainly by stereotactic brain biopsy (80%), cerebrospinal fluid analysis (7.2%), and vitrectomy (2.6%). Methotrexate-based chemotherapy with or without consolidation whole-brain radiation therapy offered better response rate and survival in the initial treatment than whole-brain radiation therapy alone. However, this observation was not present in the subsequent salvage treatments. Multivariable Cox proportional hazards regression identified age and KPS as the only prognostic indicators. Recursive partitioning analysis categorized the patients into 3 groups. Patients with KPS >70 had a favorable outcome compared with patients with KPS ≤70. This held true especially for patients age 60 and younger. The Cleveland Clinic experience with management of PCNSL demonstrated successful disease control with methotrexate-based regimens. The survival and prognostic indicators approximate those reported previously and provide independent validation for a simple yet powerful prognostic model using age and KPS to predict survival.

Migration and Gene Flow Among Domestic Populations of the Chagas Insect Vector Triatoma dimidiata (Hemiptera: Reduviidae) Detected by Microsatellite Loci.

Triatoma dimidiata (Latreille, 1811) is the most abundant and significant insect vector of the parasite Trypanosoma cruzi in Central America, and particularly in Guatemala. Tr. cruzi is the causative agent of Chagas disease, and successful disease control requires understanding the geographic distribution and degree of migration of vectors such as T. dimidiata that frequently re-infest houses within months following insecticide application. The population genetic structure of T. dimidiata collected from six villages in southern Guatemala was studied to gain insight into the migration patterns of the insects in this region where populations are largely domestic. This study provided insight into the likelihood of eliminating T. dimidiata by pesticide application as has been observed in some areas for other domestic triatomines such as Triatoma infestans. Genotypes of microsatellite loci for 178 insects from six villages were found to represent five genetic clusters using a Bayesian Markov Chain Monte Carlo method. Individual clusters were found in multiple villages, with multiple clusters in the same house. Although migration occurred, there was statistically significant genetic differentiation among villages (FR T = 0.05) and high genetic differentiation among houses within villages (FSR = 0.11). Relatedness of insects within houses varied from 0 to 0.25, i.e., from unrelated to half-sibs. The results suggest that T. dimidiata in southern Guatemala moves between houses and villages often enough that recolonization is likely, implying the use of insecticides alone is not sufficient for effective control of Chagas disease in this region and more sustainable solutions are required.

Evaluation of the sensitivity and specificity of an enzyme-linked immunosorbent assay for diagnosing brucellosis in African buffalo (Syncerus caffer).

Brucellosis is a disease of veterinary and public health importance worldwide. In sub-Saharan Africa, where the bacterium Brucella abortus has been identified in several free-ranging wildlife species, successful disease control may be dependent on accurate detection in wildlife reservoirs, including African buffalo (Syncerus caffer). We estimated the sensitivity and specificity of a commercial enzyme-linked immunosorbent assay (ELISA) (IDEXX Brucellosis Serum Ab test, IDEXX Laboratories, Westbrook, Maine, USA) for B. abortus based on a data set of 571 serum samples from 258 buffalo in the Kruger National Park, South Africa. We defined a pseudogold standard test result as those buffalo that were consistently positive or negative on two additional serologic tests, namely, the rose bengal test (RBT) and the complement fixation test (CFT). The ELISA's cutoff value was selected using receiver operating characteristics analysis, the pseudogold standard, and a threshold criterion that maximizes the total sensitivity and specificity. Then, we estimated the sensitivity and specificity of all three tests using Bayesian inference and latent class analysis. The ELISA had an estimated sensitivity of 0.928 (95% Bayesian posterior credibility interval [95% BCI] = 0.869-0.974) and specificity of 0.870 (95% BCI = 0.836-0.900). Compared with the ELISA, the RBT had a higher estimated sensitivity of 0.986 (95% BCI = 0.928-0.999), and both the RBT and CFT had higher specificities, estimated to be 0.992 (95% BCI = 0.971-0.996) and 0.998 (95% BCI = 0.992-0.999), respectively. Therefore, no single serologic test perfectly detected the antibody. However, after adjustment of cutoff values for South African conditions, the IDEXX Brucellosis Serum Ab Test may be a valuable additional screening test for brucellosis in Kruger National Park's African buffalo.

Successful control of brown root rot disease in windbreak tree stands in Okinawa, Japan

Successful control of brown root rot disease in windbreak tree stands in Okinawa, Japan

Identification of Bacterial Fish Pathogens in Brazil by Direct Colony PCR and 16S rRNA Gene Sequencing

Intensive fish farming systems in Brazil have increased the disease incidence, mainly of bacterial origin, due to higher stocking density, high organic matter levels and poor quality of the aquatic environment that causes high mortality rates during outbreaks. The identification of pathogenic species using a fast and reliable method of diagnosis is essential for successful epidemiological studies and disease control. The present study evaluated the use of direct colony PCR in combination with 16S rRNA gene sequencing to diagnose fish bacterial diseases, with the goal of reducing the costs and time necessary for bacterial identification. The method was successful for all 178 isolates tested and produced bands with the same intensity as the standard PCR performed using pure DNA. In conclusion, the genetics methods allowed detecting the most common and important pathogens in Aquaculture, including 12 species of occurrence in Brazilian fish farms. The results of the present study constitute an advance in the available diagnostic methods for bacterial pathogens in fish farms.

Efficacy of 5-Fluorouracil and High-Concentration Cisplatin Suspended in Lipiodol by Short-Term Hepatic Arterial Infusion Chemotherapy for Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

Background: Since advanced hepatocellular carcinoma (HCC) is potentially fatal, and patients’ quality of life (QOL) often deteriorates during their treatment, improving the prognosis and QOL of patients given chemotherapy is very important. In addition, cost-effective treatments are highly desirable when chemotherapy must be given repeatedly. The aim of this study was to evaluate the efficacy and usefulness of 5-fluorouracil (5-FU) and high-concentration cisplatin by short-term hepatic arterial infusion chemotherapy (3-day FPL) in advanced HCC patients. Methods: Thirty patients with unresectable advanced HCC were enrolled. The patients underwent hepatic arterial infusion chemotherapy via the implanted port system with 5-FU on days 1 - 3 and a fine-powder formulation of cisplatin in suspended pre-warmed lipiodol on day 2 every 4 to 10 weeks. Tumor response was assessed one month later with CT. Results: All patients had evidence of portal vein invasion (Vp2-4). Four patients achieved a complete response (CR), 8 patients achieved a partial response (PR), and 7 patients had stable disease (SD). The median progression-free survival (PFS) and overall survival (OS) were 198 days and 452 days, respectively. The OS was significantly longer in the successful disease control group (CR, PR, and SD) than in the progressive disease group (P

Rheumatoid: Shifting the Paradigm, Arthritis to Disease

Within the last one and half decades the treatment paradigm in RA experienced a dramatic shift from simply treat to treat to target. The introduction of biologic disease modifying anti-rheumatic drugs with their proven ability to suppress inflammation by targeting cytokines, cytokine receptors and costimulatory molecules have effectively improved the outcome of RA with a significant proportion of patients mounting up to 70% achieving successful disease control. Such advent was accompanied by collateral efforts from the ACR task force to provide evidence based updates including criteria for identification of early RA and constructing guidelines for the effective implementation of the treat to target strategy in early and established arthritis. This was further stressed upon in the ACR annual meeting in Boston 2014 where the panel strongly recommended a treat-to-target strategy, as opposed to a non-targeted approach, in both early and established rheumatoid arthritis [5-8].

First-line chemotherapy with docetaxel plus capecitabine followed by capecitabine or hormone maintenance therapy for the treatment of metastatic breast cancer patients.

The primary aim of the present study was to evaluate whether maintenance therapy with capecitabine or hormone replacement therapy (HRT) results in improved progression-free survival (PFS) in metastatic breast cancer (MBC) patients who had previously achieved disease control with first-line docetaxel plus capecitabine (TX) chemotherapy. Seventy-nine metastatic breast cancer patients treated between January 2008 and June 2013 with TX chemotherapy were retrospectively analyzed. Following successful initial disease control by the combination chemotherapy, 39 patients received single-agent capecitabine maintenance therapy and 40 patients received HRT as maintenance therapy. The PFS time, objective response rate, clinical benefit rate and safety of the two groups were compared. The median PFS of the total cohort (n=79) was 11.0 months. Furthermore, the median PFS time of the capecitabine (n=39) and HRT groups (n=40) were 10.9 and 11.1 months, respectively (P=0.283). Compared with the PFS time of maintenance treatment only, single-agent capecitabine treatment following TX chemotherapy prolonged the PFS time by 6.8 months and HRT following TX chemotherapy prolonged PFS time by 5.8 months (P=0.551). Of the total cohort, 49 patients did not receive palliative endocrine therapy prior to chemotherapy, including 22 patients in the capecitabine maintenance group and 27 patients in the HRT maintenance group. The PFS time from the commencement of maintenance treatment was significantly different between the two groups, 6.1 months in the capecitabine group compared with 11.5 months in the HRT group (P=0.045). For the 30 patients who underwent palliative endocrine therapy prior to TX chemotherapy, the PFS times of the capecitabine and HRT maintenance treatment groups were 7.5 and 4.1 months, respectively (P=0.043). However, the occurrence of adverse events, such as hematological and gastrointestinal toxicity, as well as hand-foot syndrome, were not significantly different between the two groups. The current study indicated that single-agent capecitabine maintenance therapy may be a potential treatment strategy for MBC patients who responded to capecitabine-based chemotherapy. In particular, capecitabine may provide a more effective maintenance treatment duration compared with HRT for patients who had previously undergone first-line palliative HRT for MBC.

The global health threat of African urban slums: the example of urban tuberculosis

Urban slums in developing countries are experiencing the most rapid population growth of any settlement type globally. Such growth of densely settled slums exerts a profound influence on the epidemiology and geography of communicable disease, transmitted through multiple modes. Specifically, high density, poor sanitation, poorly built housing, and lack of both adequate sewage systems and water supply facilitate pathogen spread. Long-range transmission of infection, partly through migration or travel of infected individuals, makes communicable diseases of urban areas in developing countries health problems of the entire world rather than localized areas. Non-endemic areas are threatened with disease spread. Because a significant proportion of slum growth and disease burden is in sub-Saharan Africa, global well-being demands that we understand and control disease spread in African slums as a major international health priority. This paper outlines the potential threats and implications of African urban slum health using the example of tuberculosis (TB), which is highly prevalent in developing countries. Using the case of Nima, a slum in Accra, Ghana, we argue that successful disease control efforts in developed countries depend critically on effective disease surveillance and control efforts in developing countries, including African urban slums.

Cause-related therapy: a review and suggested guidelines.

The two most common forms of oral disease, dental caries and periodontal disease, share their main etiologic factor, dental plaque. By specifically targeting their main etiologic factor, bacteria in dental plaque, cause-related therapy allows clinicians and patients to achieve successful control of these diseases. Clinicians should continuously guide and educate patients to understand the pathophysiology of their diseases so that patients will actively participate in the therapy by mechanically removing dental plaque at home. When this is combined with professional intervention (ie, removal of active caries and periodontal mechanical debridement) as well as frequent maintenance therapy, dental caries and periodontal disease can be successfully managed and controlled. This review outlines the steps and components of cause-related therapy as well as its proven long-term clinical benefit.

Early prediction of long-term response to cabergoline in patients with macroprolactinomas.

BackgroundCabergoline is typically effective for treating prolactinomas; however, some patients display cabergoline resistance, and the early characteristics of these patients remain unclear. We analyzed early indicators predicting long-term response to cabergoline.MethodsWe retrospectively reviewed the cases of 44 patients with macroprolactinomas who received cabergoline as first-line treatment; the patients were followed for a median of 16 months. The influence of various clinical parameters on outcomes was evaluated.ResultsForty patients (90.9%) were treated medically and displayed tumor volume reduction (TVR) of 74.7%, a prolactin normalization (NP) rate of 81.8%, and a complete response (CR; TVR >50% with NP, without surgery) rate of 70.5%. Most patients (93.1%) with TVR ≥25% and NP at 3 months eventually achieved CR, whereas only 50% of patients with TVR ≥25% without NP and no patients with TVR <25% achieved CR. TVR at 3 months was strongly correlated with final TVR (R=0.785). Patients with large macroadenomas exhibited a low NP rate at 3 months, but eventually achieved TVR and NP rates similar to those of patients with smaller tumors. Surgery independently reduced the final dose of cabergoline (β=-1.181 mg/week), and two of four patients who underwent surgery were able to discontinue cabergoline.ConclusionDetermining cabergoline response using TVR and NP 3 months after treatment is useful for predicting later outcomes. However, further cabergoline administration should be considered for patients with TVR >25% at 3 months without NP, particularly those with huge prolactinomas, because a delayed response may be achieved. As surgery can reduce the cabergoline dose necessary for successful disease control, it should be considered for cabergoline-resistant patients.