title: Clinical benefits of an adherence monitoring program in the management of secondary hyperparathyroidism with cinacalcet: results of a prospective randomized controlled study.
abstract: OBJECTIVE
  One of the causes of uncontrolled secondary hyperparathyroidism (sHPT) is patient's poor drug adherence. We evaluated the clinical benefits of an integrated care approach on the control of sHPT by cinacalcet.
  
  
  METHODS
  Prospective, randomized, controlled, multicenter, open-label study. Fifty hemodialysis patients on a stable dose of cinacalcet were randomized to an integrated care approach (IC) or usual care approach (UC). In the IC group, cinacalcet adherence was monitored using an electronic system. Results were discussed with the patients in motivational interviews, and drug prescription adapted accordingly. In the UC group, drug adherence was monitored, but results were not available.
  
  
  RESULTS
  At six months, 84% of patients in the IC group achieved recommended iPTH targets versus 55% in the UC group (P = 0.04). The mean cinacalcet taking adherence improved by 10.8% in the IC group and declined by 5.3% in the UC group (P = 0.02). Concomitantly, the mean dose of cinacalcet was reduced by 7.2 mg/day in the IC group and increased by 6.4 mg/day in the UC group (P = 0.03).
  
  
  CONCLUSIONS
  The use of a drug adherence monitoring program in the management of sHPT in hemodialysis patients receiving cinacalcet improves drug adherence and iPTH control and allows a reduction in the dose of cinacalcet.
authors: Division of Nephrology, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors: Valentina
authors: V
authors: Forni Ogna
authors: Menno
authors: M
authors: Pruijm
authors: Carole
authors: C
authors: Zweiacker
authors: Grégoire
authors: G
authors: Wuerzner
authors: Eric
authors: E
authors: Tousset
authors: Michel
authors: M
authors: Burnier
mesh_terms: D057966:Calcimimetic Agents / Q000627:therapeutic use; D015984:Causality; D000069449:Cinacalcet; D015897:Comorbidity; D016903:Drug Monitoring / Q000379:methods / Q000706:statistics & numerical data*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000453:epidemiology*; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000627:therapeutic use*; D015995:Prevalence; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D057966:Calcimimetic Agents; D009281:Naphthalenes; D000069449:Cinacalcet
references: J Am Soc Nephrol. 2002 Apr;13(4):1017-1024
references: 11912261
references: Am J Kidney Dis. 1998 Jul;32(1):139-45
references: 9669435
references: Clin Ther. 2001 Aug;23(8):1296-310
references: 11558866
references: Am J Kidney Dis. 1998 Apr;31(4):607-17
references: 9531176
references: Kidney Int. 2003 Jul;64(1):254-62
references: 12787417
references: Am J Manag Care. 2003 Feb;9(2):155-71
references: 12597603
references: J Am Soc Nephrol. 2001 Oct;12(10):2131-2138
references: 11562412
references: ANNA J. 1999 Jun;26(3):307-16; discussion 317, 335
references: 10633602
references: Clin Nephrol. 2009 Sep;72(3):199-205
references: 19761725
references: Semin Dial. 2005 Mar-Apr;18(2):137-41
references: 15771658
references: Can Med Assoc J. 1980 Jul 19;123(2):119-22
references: 7260749
references: J Med Econ. 2011;14(6):798-804
references: 21988567
references: J Hypertens Suppl. 2003 May;21(2):S37-42
references: 12929906
references: Diabetes Care. 1997 Oct;20(10):1512-7
references: 9314626
references: BMJ. 2008 May 17;336(7653):1114-7
references: 18480115
references: Bull World Health Organ. 2002;80(1):33-9
references: 11884971
references: Pharmacoepidemiol Drug Saf. 2006 Feb;15(2):115-21
references: 16342302
references: J Am Soc Nephrol. 2005 Mar;16(3):800-7
references: 15689407
references: N Engl J Med. 2004 Apr 8;350(15):1516-25
references: 15071126