Comparative Effectiveness of Paricalcitol versus Cinacalcet for Secondary Hyperparathyroidism in Patients Receiving Hemodialysis

Abstract

Background/Aims: Parathyroidectomies are performed when medical therapy fails to control secondary hyperparathyroidism in hemodialysis patients. The objective of this study was to compare parathyroidectomy rates in secondary hyperparathyroidism patients treated with paricalcitol or cinacalcet. Methods: Retrospective cohort study using health insurance claims from January 2001 through June 2007 for adult hemodialysis patients who were new users of paricalcitol or cinacalcet. Subjects had a minimum of 12 months’ enrollment prior to initiation of treatment and at least 30-day follow-up. Results: We identified 1,387 paricalcitol- and 1,317 cinacalcet-treated patients. The parathyroidectomy incident rate was 74% lower in the paricalcitol (0.58 per 100 patient-years) compared to the cinacalcet (2.24 per 100 patient-years) cohort, with an unadjusted rate ratio of 0.26 (95% CI 0.12–0.52). The time to parathyroidectomy from medication initiation was longer for paricalcitol than cinacalcet; however, it was not statistically significant (535 vs. 443 days, p = 0.377). A Cox proportional hazard model that adjusted for age, gender, obesity, significantly different comorbidities, and duration of hemodialysis resulted in an adjusted risk reduction for parathyroidectomy of 79% (HR = 0.21, 95% CI 0.10–0.46) for paricalcitol compared to cinacalcet. Conclusion: These data suggest that long-term treatment with paricalcitol is associated with fewer parathyroidectomies when compared to cinacalcet. Further comparative studies are needed to validate these results.

A Bayesian network analysis on comparative efficacy of treatment strategies for dialysis patients with secondary hyperparathyroidism

“…The present analysis suggested that treatment strategies with cinacalcet, cinacalcet plus low-dose active vitamin D analogues and paricalcitol were superior to conventional therapy in dialysis patients with SHPT. In addition, consistent with previous observations (25,43), it was revealed that paricalcitol may be the most effective drug for controlling PTH and serum calcium. Previously, a retrospective cohort study suggested that patients receiving paricalcitol had a 74% lower parathyroidectomy incidence rates compared with patients receiving cinacalcet (43).…”

“…In addition, consistent with previous observations (25,43), it was revealed that paricalcitol may be the most effective drug for controlling PTH and serum calcium. Previously, a retrospective cohort study suggested that patients receiving paricalcitol had a 74% lower parathyroidectomy incidence rates compared with patients receiving cinacalcet (43). Even with adjustment for comorbidities, gender, therapy time and other risk factors, the risk of parathyroidectomy was increased in the cinacalcet group compared with the paricalcitol group (43).…”

“…Previously, a retrospective cohort study suggested that patients receiving paricalcitol had a 74% lower parathyroidectomy incidence rates compared with patients receiving cinacalcet (43). Even with adjustment for comorbidities, gender, therapy time and other risk factors, the risk of parathyroidectomy was increased in the cinacalcet group compared with the paricalcitol group (43). Collectively, the data from the current study and the literature suggested that paricalcitol may provide marked benefits for treating SHPT in dialysis patients with advanced CKD.…”

Three Therapeutic Strategies: Cinacalcet, Paricalcitol or Both in Secondary Hyperparathyroidism Treatment in Hemodialysed Patients During 1-Year Observational Study—A Comparison

“…FARO 2 study showed that paricalcitol administered intravenously significantly increased the number of patients at the target for the combined endpoint composed of PTH, calcium and phosphate ( P = 0.001), although the intravenous calcitriol and paricalcitol iv and cinacalcet combination groups weren't assessed due to the low patients number (2). In the retrospective study, Schumock et al (33) compared rates of surgical intervention (parathyreoidectomy) in secondary hyperparathyroidism patients treated with paricalcitol or cinacalcet. They found that long-term treatment with paricalcitol was connected with lower number of parathyroidectomies in comparison with the patients treated with cinacalcet.…”

Comparison of Health Care Utilization and Costs for Patients with Asthma by Severity and Health Insurance in Thailand

“…These two latest criteria were set to ensure the continuity of care of the patients. The patients who met the criteria were likely to receive the treatment for asthma at the study site [14][15][16]. The index date for each patient was the first diagnosis date during the study period.…”