Experience in the treatment of primary hyperparathyroidism with cinacalcet: Preliminary data
I. Luque-Fernández1, A. García-Martín2, A. Luque-Pazos1, J. Sastre-Marcos1, A. Marco-Martínez1, A. Vicente-Delgado1 & V. Peña-Cortés1
Introduction: Cinacalcet is an oral calcimimetic indicated in treatment of primary hyperparathyroidism if patients do not accept surgery, do not carry out the surgical criteria, there is failure of previous surgery or serious comorbidity that makes surgery impossible.
Methods: Descriptive study that included 34 patients with primary hyperparathyroidism treated with cinacalcet. We recorded clinical and biochemical data before and after 6 months of treatement, dose and time of treatment, and adverse events.
Results: Median time of treatment was 10 months (242 months). 24 patients complete 6 months of treatment. Reasons for treatment with cinacalcet were 8 patients refusal to parathyroidectomy, 4 surgery not possible due to comorbidities and 21 progressive hypercalcemia prior to surgery. Cinacalcet initial dose was 30 mg/12 hours in 94% and 30 mg/24 h in 6%. Serum calcium level decreased significantly from 11.6±0.9 mg/dl at baseline to 10.1±0.9 mg/dl (P<0.01) at six months; also did serum phosphorus level (2.4±0.35 mg/dl to 2.75±0.35 mg/dl p <0.01) whereas serum PTHi level did not differ significantly before and after treatment (150±101.96 pg/ml vs 162,6±120.79 pg/ml P=0.583). Normocalcemia (S-Ca <10.1 mg/dl) was achieved in 44.1% of patients.
Most common adverse events were nausea and vomiting, especially at the beginning of therapy (8.8%). 4 required dose decrease and 3 withdrawal of treatment.
Conclusion: Cinacalcet is an effective alternative in non-surgical treatment of primary hyperparathyroidism in patients with recurrent disease or in case of surgical contraindications. Furthermore, cinacalcet may be useful in the preoperative hypercalcemia management.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.