Clinical experience with cinacalcet HCl.
Secondary hyperparathyroidism (SHPT) is associated with parathyroid gland hyperplasia, increased parathyroid hormone (PTH) production and secretion, disturbed bone and mineral metabolism, soft tissue calcification and an increased risk of death. The condition is an almost universal complication of end-stage renal disease (ESRD) and currently is managed by treatment with phosphate binders and vitamin D compounds, both of which are associated with significant side effects, including hypercalcaemia and hyperphosphataemia. Therapy with calcimimetics is a new approach to the treatment of SHPT. These agents act at the calcium-sensing receptor (CaR), where they increase the sensitivity of the receptor to ionized serum calcium. Activation of the CaR results in a rapid reduction in PTH secretion. The calcimimetic drug cinacalcet HCl currently is undergoing clinical trials in dialysis patients who have uncontrolled SHPT, despite treatment with vitamin D compounds and/or phosphate binders. Clinical trials have confirmed that the drug rapidly reduces plasma PTH, phosphorus and calcium-phosphorus product (Ca x P) levels, and that levels of PTH, phosphorus and Ca x P remain suppressed for up to 3 years. In clinical trials, cinacalcet HCl was a well-tolerated drug; only nausea and vomiting occurred more frequently in patients who took cinacalcet HCl than in those who took placebo, and the occurrence of transient hypocalcaemia was limited to the initial phase of the treatment. Cinacalcet HCl is therefore a potentially highly effective and well-tolerated treatment for SHPT in patients with ESRD.
Ureña Torres
Pablo
P
Clinique de l'Orangerie, Service de Néphrologie-Dialyse, 11 boulevard Anatole France, 93300 Aubervilliers, France. urena.pablo@wanadoo.fr
D000469:Alkaline Phosphatase / Q000097:blood; D000069449:Cinacalcet; D017326:Clinical Trials, Phase III as Topic; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D009281:Naphthalenes / Q000494:pharmacology / Q000627:therapeutic use*; D010280:Parathyroid Glands / Q000187:drug effects; D010758:Phosphorus / Q000097:blood; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis
D009281:Naphthalenes; D010758:Phosphorus; D000469:Alkaline Phosphatase; D000069449:Cinacalcet