Cinacalcet (Sensipar) Provides no Measurable Clinical Benefits for Patients with Primary Hyperparathyroidism and may Accelerate Bone Loss with Prolonged Use

Norman, James; López, José E.; Politz, Doug

doi:10.1245/s10434-011-2065-9

Cited by 15 publications

(8 citation statements)

References 20 publications

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“…In general, cinacalcet normalizes serum calcium and modestly reduces PTH 67 – 69 . These studies have not shown any positive effects of cinacalcet on BMD or non-specific symptoms of the disease 68 , 69 . Peacock et al evaluated patients with severe or mild disease and found normalization in serum calcium and decrease in PTH in both groups 69 .…”

Section: Medical Managementmentioning

confidence: 74%

Primary Hyperparathyroidism

Bandeira

Bilezikian

2016

F1000Res

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Over the past several generations, primary hyperparathyroidism (PHTP) has undergone a change in its clinical presentation in many countries from a symptomatic disease to an asymptomatic one. The reasons for this change in clinical presentation are related to the widespread use of biochemical screening tests, to the measurement of PTH more routinely in the evaluation of metabolic bone disease and to the status of vitamin D sufficiency in the population. Along with recognition of a broader clinical spectrum of disease, including a more recently recognized normocalcemic variant, has come an appreciation that the evaluation of classic target organs that can be affected in PHPT, such as the skeleton and the kidneys, require more advanced imaging technology for complete evaluation. It is clear that even in asymptomatic patients, evidence for microstructural disease in the skeleton and calcifications in the kidneys can be demonstrated often. Potential non-classical manifestations of PHPT related to neurocognition and the cardiovascular system continue to be of interest. As a result of these advances, revised guidelines for the management of asymptomatic PHPT have been recently published to help the clinician determine whether surgery is appropriate or whether a more conservative approach is acceptable.

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Section: Medical Managementmentioning

confidence: 74%

Primary Hyperparathyroidism

Bandeira

Bilezikian

2016

F1000Res

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“…Also, cinacalcet administration in patients with primary hyperparathyroidism does not improve their BMD [21]. In addition, a recent study by Norman et al [22] reports that prolonged use of cinacalcet is associated with continued bone loss in patients with primary hyperparathyroidism. In the cinacalcet group of our study, BMD was found increased before treatment was commenced, presumably because 4 of 8 patients were receiving paricalcitol.…”

Section: Discussionmentioning

confidence: 99%

Impact of Long-Term Cinacalcet, Ibandronate or Teriparatide Therapy on Bone Mineral Density of Hemodialysis Patients: A Pilot Study

et al. 2012

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Background: Insufficient evidenced-based information is available for the treatment of osteoporosis in hemodialysis (HD) patients. Methods: In 102 HD patients, bone mineral density (BMD) was measured twice 16 ± 3 months apart. In the second BMD measurement 66 of them had a femoral neck (FN) T-score <–2.5. Of these 66 patients, 38 consented to a bone biopsy. Depending on both the bone biopsy findings and parathyroid hormone levels, patients were assigned to treatment groups. Eleven patients with osteitis fibrosa and iPTH >300 pg/ml received cinacalcet, 11 with osteitis fibrosa and iPTH <300 pg/ml received ibandronate, 9 with adynamic bone disease received teriparatide, and 7 with mild abnormalities received no treatment. A third BMD measurement was done after an average treatment period of 13–16 months. We compared the annual percent change of FN and lumbar spine (LS) BMD before and during treatment. Results: FN and LS BMD decreased significantly in the cinacalcet group, with an annual change of 3.6 and 3.4% before treatment to –4.2% (p = 0.04) and –7.7% (p = 0.02) during treatment, respectively. In the teriparatide group, FN and LS BMD increased, although not significantly, with an annual change of –5.4 and –2.6% before treatment to 2.7 and 4.9% during treatment, respectively. In both the ibandronate and the no treatment groups, BMD change rate remained negative during the whole study. Conclusions: Teriparatide administration improved BMD in HD patients with adynamic bone disease, although these results did not reach statistical significance. In HD patients with osteitis fibrosa, ibandronate did not improve BMD while cinacalcet reduced BMD.

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“…The majority of indications for cinacalcet treatment are either for contraindication or refusal for surgery ( 19 , 21 , 22 , 24 , 26 , 27 , 28 , 29 , 31 , 32 , 33 , 35 , 36 , 39 , 43 ), reduction in serum Ca levels prior to surgery ( 18 , 20 , 26 , 27 , 31 , 40 , 41 ) or to treat refractory hypercalcemia despite parathyroidectomy ( 16 , 19 , 22 , 27 , 28 , 29 , 31 , 32 , 35 , 36 , 38 , 41 , 43 ).…”

Section: Resultsmentioning

confidence: 99%

“…Literature review A total of 1301 articles were identified after duplicates removal, and eventually 28 articles were included in the review (16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43), of which 8 were conference proceedings (20,24,25,30,31,32,41,42) (Fig. 1).…”

Section: Meta-analysismentioning

confidence: 99%

Cinacalcet and primary hyperparathyroidism: systematic review and meta regression

Chin

Tan

et al. 2020

Endocrine Connections

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Purpose: Primary hyperparathyroidism (PHPT) is common condition, affecting people of all ages and is mainly treated with parathyroidectomy. Cinacalcet has been widely used in secondary or tertiary hyperparathyroidism, but the use of cinacalcet in PHPT is less clear. Methods: Searches were conducted in Medline and Embase for cinacalcet use in PHPT from induction to 10th April 2020. Articles and conferences abstracts describing the use of cinacalcet for PHPT in prospective or retrospective cohorts and randomized controlled trials restricted to English Language only. We initially identified 1301 abstracts. Each article went extraction by two blinded authors on a structured proforma. Continuous outcomes were pooled with weight mean difference (WMD). Quality of included articles was assessed with Newcastle Ottwa Scale and Cochrane risk of Bias 2.0. Results: 28 articles were included. Normalization rate of serum calcium levels was reported at 90% (CI: 0.82 to 0.96). Serum levels of calcium and PTH levels were significantly reduced (calcium, WMD: 1.647 (CI: -1.922 to -1.371; PTH, WMD: -31.218, CI: -41.671 to -20.765) and phosphate levels significantly increased (WMD: 0.498, CI: 0.400 to 0.596) after cinacalcet therapy The higher the baseline calcium levels, the greater calcium reduction with cinacalcet treatment. Age and gender did not modify the effect of cinacalcet on serum calcium levels. Conclusion: The results from the meta-analysis support the use of cinacalcet as an alternative or bridging therapy to treat hypercalcemia in people with PHPT.

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Cinacalcet (Sensipar) Provides no Measurable Clinical Benefits for Patients with Primary Hyperparathyroidism and may Accelerate Bone Loss with Prolonged Use

Cited by 15 publications

References 20 publications

Primary Hyperparathyroidism

Primary Hyperparathyroidism

Impact of Long-Term Cinacalcet, Ibandronate or Teriparatide Therapy on Bone Mineral Density of Hemodialysis Patients: A Pilot Study

Cinacalcet and primary hyperparathyroidism: systematic review and meta regression

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