Method: We carried out a retrospective audit of baseline data for patients under our care with primary hyperparathyroidism on cinacalcet therapy, against the NHS England Clinical Commissioning Policy (July 2016). Patients with secondary hypercalcaemia due to end stage renal failure were excluded.
Results: 40 patients were identified, 9 men and 31 women, with an age range of 3289 years (median age 78). 3 patients were under 50 years of age. Pre-treatment, 21 patients (52,5%) had severe hypercalcaemia (serum calcium >3 mmol/L), 11 (27.5%) had moderate hypercalcaemia (serum calcium 2.85-3 mmol/L) and 8 (20%) had mild hypercalcaemia (serum calcium <2.85 mmol/L). The median baseline vitamin D was 40 nmol/L (range 8 151 nmol/L); 26 patients (65%) had a vitamin D >50 nmol/L. 19 patients (47.5%) had symptomatic hypercalcaemia. 11 patients (27.5%) had a history of renal stones. All patients met at least one of the indications for parathyroidectomy. 15/40 (37.5%) were unfit for surgery; 12/40 (30%) refused surgery; and 13/40 (32.5%) were treated with cinacalcet whilst awaiting surgery.
Conclusions: Our results show that to meet the NHS England prescribing criteria for cinacalcet we need to change some aspects of our previous practice, including the use of cinacalcet for patients with a serum calcium <2.85 mmol/L and the use of cinacalcet prior to parathyroidectomy operations. We also need to ensure all patients are vitamin D replete. We are now including all medically managed patients in our parathyroid MDT discussions and auditing cinacalcet prescribing prospectively.