From the Guidelines
The pharmacological treatment of choice for patients with secondary hyperparathyroidism is typically cinacalcet, a calcimimetic agent, which can be prescribed when PTH levels reach 85 pmol/L and standard therapy is ineffective, as recommended by the National Institute for Health and Care Excellence guideline 1. The treatment approach for secondary hyperparathyroidism (SHPT) involves a combination of dietary modifications, phosphate binders, vitamin D supplementation, and adjustment of the dialysis regimen.
- In patients with SHPT who do not respond to standard therapy and in whom surgery is contraindicated, cinacalcet can be prescribed, as it increases the sensitivity of the calcium-sensing receptors, thereby decreasing PTH production 1.
- The use of active vitamin D analogs, such as calcitriol or alfacalcidol, is also recommended, particularly in patients with vitamin D deficiency-related SHPT, as they help regulate parathyroid hormone levels and improve bone histology 1.
- Phosphate binders, such as sevelamer, calcium acetate, or lanthanum carbonate, are important for controlling hyperphosphatemia, which is a common complication in patients with SHPT 1.
- Regular monitoring of calcium, phosphorus, and PTH levels is essential to adjust medication dosages and prevent complications like hypercalcemia or adynamic bone disease 1.
- It is also important to note that the treatment approach may vary depending on the underlying cause of SHPT, and a multidisciplinary team approach is recommended to discuss treatment plans and adjust them as needed 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Secondary Hyperparathyroidism Cinacalcet tablets are indicated for the treatment of secondary hyperparathyroidism (HPT) in adult patients with chronic kidney disease (CKD) on dialysis [see Clinical Studies (14. 1)].
The pharmacological treatment choice for patients with secondary hyperparathyroidism is cinacalcet (PO), specifically for adult patients with chronic kidney disease (CKD) on dialysis 2.
From the Research
Pharmacological Treatment Options
The pharmacological treatment choice for patients with secondary hyperparathyroidism includes:
- Cinacalcet, a calcimimetic that decreases parathyroid hormone secretion 3, 4, 5
- Paricalcitol, a vitamin D receptor activator that reduces parathyroid hormone levels 3, 4, 6
- Combination therapy with paricalcitol and cinacalcet, although studies suggest that this combination may not provide additional benefits compared to paricalcitol alone 3, 4, 6
Treatment Outcomes
Studies have shown that:
- Paricalcitol treatment can significantly decrease iPTH levels in hemodialysed patients 3, 4, 6
- Cinacalcet treatment can also reduce iPTH levels, although the decrease may not be as significant as with paricalcitol 3, 5
- Combination therapy with paricalcitol and cinacalcet may not provide additional benefits in terms of iPTH level reduction 3, 4, 6
Safety and Efficacy
The safety and efficacy of these treatment options have been evaluated in several studies, with results indicating that:
- Paricalcitol treatment has a good safety profile, with no severe hypercalcemia or hypocalcemia observed 3, 4
- Cinacalcet treatment can also be safe and effective, although it may be associated with a higher cost 5
- Combination therapy with paricalcitol and cinacalcet may be considered for selected patients, such as those with hypocalcemia after calcimimetics 6