title: Anti-parathyroid treatment effectiveness and persistence in incident haemodialysis patients with secondary hyperparathyroidism.
abstract: BACKGROUND
  Anti-parathyroid treatment initiation and discontinuation are important decisions in chronic haemodialysis (HD) patients, where pill burden is often excessive. The present study aimed to describe secondary hyperparathyroidism (sHPT) drug therapy changes in HD patients.
  
  
  METHODS
  Retrospective observational cohort study of incident European HD patients with sHPT who were prescribed calcitriol or alfacalcidol (alpha calcitriol), paricalcitol or cinacalcet.
  
  
  RESULTS
  Treatment-naïve patients prescribed alpha calcitriol (N=2259), paricalcitol (N=1689) and cinacalcet (N=1245) were considered for analysis. Serum intact parathyroid hormone (iPTH) levels decreased post-initiation with all treatment modalities; serum calcium and phosphate levels increased in response to activated vitamin D derivatives but decreased with cinacalcet. Approximately one-third of alpha calcitriol and paricalcitol patients but less than one-quarter of cinacalcet patients discontinued treatment. Although the three groups had comparable serum iPTH control at the time of treatment discontinuation, they differed in terms of calcium and phosphate levels. Following discontinuation, the evolution of laboratory parameters differed by treatment modality: whilst iPTH increased for all three treatment groups, calcium and phosphate decreased in patients who were being treated with alpha calcitriol and paricalcitol at the time of discontinuation, and increased in those who had been treated with cinacalcet.
  
  
  CONCLUSIONS
  In conditions of daily clinical practice, attaining and maintaining recommended biochemical control of sHPT appears to be more frequently achievable with cinacalcet than with activated vitamin D compounds.
authors.affiliation: Servicio de Nefrología, Hospital Universitario Valdecilla, Universidad de Cantabria, Santander, Spain. Electronic address: angelmartindefrancisco@gmail.com.
authors.forename: Angel Luis Martín
authors.initials: AL
authors.lastname: de Francisco
authors.affiliation: Center for Observational Research (CfOR), Amgen Ltd, Uxbridge, United Kingdom.
authors.forename: Iain Andrew
authors.initials: IA
authors.lastname: Gillespie
authors.affiliation: On behalf of Amgen Ltd, United Kingdom.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Gioni
authors.affiliation: Nephrology, RWTH University of Aachen, Aachen, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Floege
authors.affiliation: Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Kronenberg
authors.affiliation: EMEALA Medical Board, Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marcelli
authors.affiliation: Center for Nephrology, Division of Medicine, University College London, United Kingdom.
authors.forename: David Collins
authors.initials: DC
authors.lastname: Wheeler
authors.affiliation: International Development Nephrology, Amgen Europe GmbH, Zug, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Froissart
authors.affiliation: Inserm U 1088, UFR Médecine/Pharmacie, Université de Picardie, Amiens, France.
authors.forename: Tilman Bernhard
authors.initials: TB
authors.lastname: Drueke
mesh_terms: D057966:Calcimimetic Agents / Q000627:therapeutic use*; D002118:Calcium; D000069449:Cinacalcet / Q000627:therapeutic use*; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy*; D010281:Parathyroid Hormone; D006435:Renal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D057966:Calcimimetic Agents; D010281:Parathyroid Hormone; D002118:Calcium; D000069449:Cinacalcet
keywords: Alteraciones del metabolismo oseo-mineral en la enfermedad renal crónica; Chronic kidney disease; Chronic kidney disease-mineral and bone disorder; Enfermedad renal crónica; Haemodialysis; Hemodiálisis; Hiperparatiroidismo secundario; Inicio del tratamiento; Interrupción del tratamiento; Mantenimiento del tratamiento; Secondary hyperparathyroidism; Treatment discontinuation; Treatment initiation; Treatment persistence