Endocrine Abstracts

Introduction: Cinacalcet, a calcimimetic first approved for use in 2004, has become a mainstay of treatment in those awaiting or unable to undergo surgery for primary hyperparathyroidism. In this retrospective study, we aimed to map clinical outcomes in patients who had been prescribed cinacalcet for a suspected or confirmed diagnosis of primary hyperparathyroidism, between 1^st October 2022 and 30^th September 2024, and to compare our practice with NICE guideline NG132, published in 2019.

Methodology: All instances where cinacalcet was dispensed from a pharmacy within the trust were logged – biochemical, demographic and clinical data were then gathered. Any patients with chronic or end-stage renal disease were excluded.

Results: Eighty-four patients were identified - 55 female (65%) and 29 male - with ages ranging from 25-90 (mean age 67). 37% (n =31) were referred for parathyroidectomy (mean age 50); 16% (n =14) went on to have surgery (mean age 56). Two patients had recurrence of hypercalcaemia post-operatively, and were subsequently restarted on cinacalcet; the remainder were cured. Seventy-one of the 84 patients were prescribed cinacalcet after NG132 was published – of these, 49% (n =35) were prescribed cinacalcet in adherence with the guidelines; in those where cinacalcet was prescribed outwith the guidelines, all but one was prescribed cinacalcet while awaiting surgery.

Conclusions: Cinacalcet was prescribed in adherence with NICE guideline NG132 in just under half of cases; the overwhelming majority of prescriptions outwith the guidelines were for use as bridging therapy while awaiting parathyroid surgery – this is consistent with evidence elsewhere within the literature, and should be a key consideration to take into account for future guidelines, given the well-documented use of cinacalcet peri-operatively. Surgical outcomes were very favourable, with 85% of patients cured following surgery.