title: A study of maintenance therapy after intravenous maxacalcitol for secondary hyperparathyroidism.
abstract: OBJECTIVE
  Intravenous vitamin D therapy is an established treatment for secondary hyperparathyroidism (SHPT). However, no protocols have been established for maintenance therapy with intravenous or oral vitamin D after control of intact parathyroid hormone (iPTH) within the target range.
  
  
  METHODS
  Step I. For patients with SHPT (200 ≤ iPTH ≤ 500 pg/ml), a dose of 2.5 mg maxacalcitol (OCT) was administered intravenously three times a week with oral sevelamer hydrochloride; the dose was increased to a 10 µg maximum three times a week to control iPTH to < 150 pg/ml. Step II. When iPTH reached the target level, patients were assigned to Group A (oral alfacalcidol 1.0 µg/day) or B (oral alfacalcidol 0.25 µg/ day). Serum iPTH, calcium, and inorganic phosphorus were measured each month for 6 months. Maintenance rates for the target iPTH levels were evaluated, < 150 pg/ml at Step I and < 200 pg/ml at Step II.
  
  
  RESULTS
  iPTH decreased to < 150 pg/ml by OCT in 24 of 35 patients (68.6%). During the 24-week observation period, iPTH was controlled for 83.3% patients in Group A vs. 36.4% for Group B (p < 0.05). No dropouts due to hypercalcemia or hyperphosphatemia occurred.
  
  
  CONCLUSIONS
  OCT dose titration was effective for SHPT. A higher daily dose of oral alfacalcidol (1.0 µg) appears to be more effective than a lower dose (0.25 µg) as maintenance therapy after iPTH control.
authors.affiliation: Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Arao, Japan. m-adachi@gpo.kumamoto-u-ac.jp
authors.forename: M
authors.initials: M
authors.lastname: Adachi
authors.forename: T
authors.initials: T
authors.lastname: Miyoshi
authors.forename: N
authors.initials: N
authors.lastname: Shiraishi
authors.forename: H
authors.initials: H
authors.lastname: Shimada
authors.forename: S
authors.initials: S
authors.lastname: Sakaguchi
authors.forename: K
authors.initials: K
authors.lastname: Tomita
authors.forename: K
authors.initials: K
authors.lastname: Kitamura
mesh_terms: D000284:Administration, Oral; D000368:Aged; D015415:Biomarkers / Q000097:blood; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002117:Calcitriol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy*; D007262:Infusions, Intravenous; D008297:Male; D011073:Polyamines / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D006435:Renal Dialysis; D000069603:Sevelamer; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D050071:Bone Density Conservation Agents; D011073:Polyamines; D000069603:Sevelamer; D002117:Calcitriol; C051883:maxacalcitol