A single-centre retrospective analysis of cinacalcet therapy in primary hyperparathyroidism

Primary hyperparathyroidism (pHPT) is a common endocrine disorder that can be cured by parathyroidectomy; patients unsuitable for surgery can be treated with cinacalcet. Availability of surgery may be reduced during COVID-19, and cinacalcet can be used as bridging therapy. In this single-centre retr...

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Autores principales:	Daniel Bell, Julia Hale, Cara Go, Ben G Challis, Tilak Das, Brian Fish, Ruth T Casey
Formato:	article
Lenguaje:	EN
Publicado:	Bioscientifica 2021
Materias:	cinacalcet calcium primary hyperparathyroidism Diseases of the endocrine glands. Clinical endocrinology RC648-665
Acceso en línea:	https://doi.org/10.1530/EC-21-0258 https://doaj.org/article/4ebafbe31ad84dc6ac02710a0db56610
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spelling	oai:doaj.org-article:4ebafbe31ad84dc6ac02710a0db566102021-11-10T12:20:39ZA single-centre retrospective analysis of cinacalcet therapy in primary hyperparathyroidismhttps://doi.org/10.1530/EC-21-02582049-3614https://doaj.org/article/4ebafbe31ad84dc6ac02710a0db566102021-11-01T00:00:00Zhttps://ec.bioscientifica.com/view/journals/ec/10/11/EC-21-0258.xmlhttps://doaj.org/toc/2049-3614Primary hyperparathyroidism (pHPT) is a common endocrine disorder that can be cured by parathyroidectomy; patients unsuitable for surgery can be treated with cinacalcet. Availability of surgery may be reduced during COVID-19, and cinacalcet can be used as bridging therapy. In this single-centre retrospective analysis, we investigated the utility and safety of cinacalcet in patients with pHPT receiving cinacalcet between March 2019 and July 2020, including pre-parathyroidectomy bridging. We reviewed and summarised the published literature. Cinacalcet dosages were adjusted by endocrinologists to achieve target calcium < 2.70 mmol/L. Eighty-six patients were identifie d, with the most achieving target calcium (79.1%) with a mean dose of 39.4 mg/day (±17.1 mg/day) for a median duration of 35 weeks (1–178 weeks). Calcium was normalised in a median time of 5 weeks. The majority of patients commenced cinacalcet of 30 mg/day (78 patients) with the remainder at 60 mg/day (8 patients). Forty-seven patients commencing lower dose cinacalcet (30 mg/day) achieved target calcium without requiring 60 mg/day. Baseline PTH was significantly higher in patients requiring higher doses of cinacalcet. 18.6% of patients reported adverse reactions and 4.7% discontinued cinacalcet. Patients treated with cinacalcet pre-parathyroidectomy required a higher dose and fewer achieved target calcium compared to medical treatment with cinacalcet alone. Post-operative calcium was similar to patients who were not given pre-parathyroidectomy cinacalcet. In summary, cinacalcet at an initial dose of 30 mg/day is safe and useful for achieving target calcium in patients with symptomatic or severe hypercalcaemia in pHPT, including those treated for pre-parathyroidectomy. We propose a PTH threshold of >30 pmol/L to initiate at a higher dose of 60 mg/day.Daniel BellJulia HaleCara GoBen G ChallisTilak DasBrian FishRuth T CaseyBioscientificaarticlecinacalcetcalciumprimary hyperparathyroidismDiseases of the endocrine glands. Clinical endocrinologyRC648-665ENEndocrine Connections, Vol 10, Iss 11, Pp 1435-1444 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	cinacalcet calcium primary hyperparathyroidism Diseases of the endocrine glands. Clinical endocrinology RC648-665
spellingShingle	cinacalcet calcium primary hyperparathyroidism Diseases of the endocrine glands. Clinical endocrinology RC648-665 Daniel Bell Julia Hale Cara Go Ben G Challis Tilak Das Brian Fish Ruth T Casey A single-centre retrospective analysis of cinacalcet therapy in primary hyperparathyroidism
description	Primary hyperparathyroidism (pHPT) is a common endocrine disorder that can be cured by parathyroidectomy; patients unsuitable for surgery can be treated with cinacalcet. Availability of surgery may be reduced during COVID-19, and cinacalcet can be used as bridging therapy. In this single-centre retrospective analysis, we investigated the utility and safety of cinacalcet in patients with pHPT receiving cinacalcet between March 2019 and July 2020, including pre-parathyroidectomy bridging. We reviewed and summarised the published literature. Cinacalcet dosages were adjusted by endocrinologists to achieve target calcium < 2.70 mmol/L. Eighty-six patients were identifie d, with the most achieving target calcium (79.1%) with a mean dose of 39.4 mg/day (±17.1 mg/day) for a median duration of 35 weeks (1–178 weeks). Calcium was normalised in a median time of 5 weeks. The majority of patients commenced cinacalcet of 30 mg/day (78 patients) with the remainder at 60 mg/day (8 patients). Forty-seven patients commencing lower dose cinacalcet (30 mg/day) achieved target calcium without requiring 60 mg/day. Baseline PTH was significantly higher in patients requiring higher doses of cinacalcet. 18.6% of patients reported adverse reactions and 4.7% discontinued cinacalcet. Patients treated with cinacalcet pre-parathyroidectomy required a higher dose and fewer achieved target calcium compared to medical treatment with cinacalcet alone. Post-operative calcium was similar to patients who were not given pre-parathyroidectomy cinacalcet. In summary, cinacalcet at an initial dose of 30 mg/day is safe and useful for achieving target calcium in patients with symptomatic or severe hypercalcaemia in pHPT, including those treated for pre-parathyroidectomy. We propose a PTH threshold of >30 pmol/L to initiate at a higher dose of 60 mg/day.
format	article
author	Daniel Bell Julia Hale Cara Go Ben G Challis Tilak Das Brian Fish Ruth T Casey
author_facet	Daniel Bell Julia Hale Cara Go Ben G Challis Tilak Das Brian Fish Ruth T Casey
author_sort	Daniel Bell
title	A single-centre retrospective analysis of cinacalcet therapy in primary hyperparathyroidism
title_short	A single-centre retrospective analysis of cinacalcet therapy in primary hyperparathyroidism
title_full	A single-centre retrospective analysis of cinacalcet therapy in primary hyperparathyroidism
title_fullStr	A single-centre retrospective analysis of cinacalcet therapy in primary hyperparathyroidism
title_full_unstemmed	A single-centre retrospective analysis of cinacalcet therapy in primary hyperparathyroidism
title_sort	single-centre retrospective analysis of cinacalcet therapy in primary hyperparathyroidism
publisher	Bioscientifica
publishDate	2021
url	https://doi.org/10.1530/EC-21-0258 https://doaj.org/article/4ebafbe31ad84dc6ac02710a0db56610
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A single-centre retrospective analysis of cinacalcet therapy in primary hyperparathyroidism

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