New strategies for the treatment of hyperparathyroidism incorporating calcimimetics.
BACKGROUND
Hyperparathyroidism (HPT), characterised by increased parathyroid hormone (PTH) secretion and parathyroid hyperplasia, can be caused by physiologic defects in the parathyroid gland (primary HPT [PHPT]) or as a consequence of declining renal function (secondary HPT [SHPT]).


OBJECTIVE
To review the safety and efficacy of cinacalcet in the treatment of SHPT and PHPT.


METHODS
Studies indexed in NLM/PubMed investigating the safety, efficacy, and pharmacokinetics of cinacalcet for PHPT and SHPT and supporting preclinical evidence.


CONCLUSIONS
Recent evidence has demonstrated the efficacy of the calcimimetic cinacalcet in the treatment of PHPT and SHPT. Compared with traditional therapies such as vitamin D sterols and phosphate binders, cinacalcet treatment can allow an increased proportion of patients with SHPT to improve Kidney Disease Outcomes Quality Initiative (KDOQI) Bone Metabolism and Disease laboratory parameter target attainment. Recent evidence suggests that improvements in these biochemical parameters with cinacalcet can translate into improved morbidity and mortality. Cinacalcet lowers PTH and calcium in patients following renal transplantation, and also normalises serum calcium in patients with PHPT. Ongoing studies are focusing and future studies are likely to focus on the effect of cinacalcet on clinical outcomes and on novel strategies for the integration of cinacalcet with traditional therapies to improve serum PTH and mineral metabolism control.
de Francisco
Angel L M
AL
Servicio de Nefrologia, Hospital Universitario Valdecilla, Avda Valdecilla s/n, E-39008 Santander, Spain. martinal@unican.es
D000818:Animals; D002118:Calcium / Q000378:metabolism; D000069449:Cinacalcet; D018849:Controlled Clinical Trials as Topic; D004353:Drug Evaluation, Preclinical; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006965:Hyperplasia; D016030:Kidney Transplantation; D009281:Naphthalenes / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D010280:Parathyroid Glands / Q000473:pathology; D010281:Parathyroid Hormone / Q000378:metabolism; D051437:Renal Insufficiency / Q000150:complications
D009281:Naphthalenes; D010281:Parathyroid Hormone; D002118:Calcium; D000069449:Cinacalcet