Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2009) 20 P227

ECE2009 Poster Presentations Bone/Calcium (42 abstracts)

Experience with cinacalcet in primary hyperparathyroidism: results from the Swiss primary hyperparathyroidism cohort study

Christian Meier 1 , Andrea Trombetti 2 , Christoph Henzen 3 , Andreas Rohrer 4 , F Hermann 2 , Michael Braendle 5 , Emanuel Christ 6 , Rene Rizzoli 2 & Marius Kraenzlin 1

1Division of Endocrinology and Diabetology, University Hospital, Basel, Switzerland; 2Bone Disease Service, University Hospital, Geneva, Switzerland; 3Department of Internal Medicine, Kantonsspital, Lucerne, Switzerland; 4Endocrine Clinic, Chur, Switzerland; 5Division of Endocrinology and Diabetes, Kantonsspital, St Gallen, Switzerland; 6Department of Endocrinology and Diabetes, University Hospital, Berne, Switzerland.

Objective: Cinacalcet, a calcimimetic that reduces parathyroid hormone (PTH) secretion and serum calcium (S-Ca) levels by increasing the sensitivity of calcium-sensing receptors has been introduced for the treatment of patients with persistent or recurrent primary hyperparathyroidism (PHPT). Within a prospective, non-interventional cohort study we identified patients with newly diagnosed PHPT who have been started on cinacalcet. Patient characteristics, treatment indications and biochemical follow-up are presented.

Methods: The Swiss Primary Hyperparathyroidism Cohort Study is an ongoing prospective project initiated in June 2007. Clinical, biochemical and densitometric data are recorded systematically at least every 6 months according to NIH guidelines. Currently 110 patients with PHPT (74% female) have been included. Thirteen patients with PHPT (12%) have been started on cinacalcet treatment.

Results: As compared to the entire cohort of patients with PHPT, patients starting cinacalcet were younger (57.7±17.1 vs 70.0±14.4 years, P=0.02) and had higher S-Ca levels (3.19±0.61 vs 2.74±0.30 mmol/l, P<0.001). Serum iPTH levels were comparable (19.0±10.6 vs 16.9±13.4 pmol/l, P=0.28). Reasons for starting cinacalcet were progressive (n=7) or symptomatic (n=3) hypercalcemia, patient refusal to parathyroidectomy (PTX, n=2), or recurrent PHPT after unsuccessful PTX (n=1). Median daily cinacalcet dose was 60 mg (range, 30–420 mg). During cinacalcet therapy S-Ca levels decreased from 3.19 to 2.55 mmol/l (P=0.008); normocalcemia (S-Ca <2.60 mmol/l) was achieved in 55% of patients. The treatment was well tolerated. All patients had at least partial relief of hypercalcemia-related symptoms (depression, fatigue, musculo-skeletal symptoms).

Conclusion: Our preliminary results show that cinacalcet use results in biochemical and clinical improvement in patients with PHPT and therefore may have the potential as a non-surgical alternative in patients with recurrent disease or in case of surgical contraindications. Furthermore, cinacalcet may be warranted in the preoperative management to test reversibility in patients with symptomatic hypercalcemia.

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