Parathyroid Hormone Therapy for Managing Chronic Hypoparathyroidism: A Systematic Review and Meta-Analysis

Abstract

The efficacy and safety of parathyroid hormone (PTH) therapy for managing long‐term hypoparathyroidism is being evaluated in ongoing clinical trials. We undertook a systematic review and meta‐analysis of currently available randomized controlled trials to investigate the benefits and harms of PTH therapy and conventional therapy in the management of patients with chronic hypoparathyroidism. To identify eligible studies, published in English, we searched Embase, PubMed, and Cochrane CENTRAL from inception to May 2022. Two reviewers independently extracted data and assessed the risk of bias. We defined patients' important outcomes and used grading of recommendations, assessment, development, and evaluation (GRADE) to provide the structure for quantifying absolute effects and rating the quality of evidence. Seven randomized trials of 12 publications that enrolled a total of 386 patients proved eligible. The follow‐up duration ranged from 1 to 36 months. Compared with conventional therapy, PTH therapy probably achieves a small improvement in physical health‐related quality of life (mean difference [MD] 3.4, 95% confidence interval [CI] 1.5–5.3, minimally important difference 3.0, moderate certainty). PTH therapy results in more patients reaching 50% or greater reduction in the dose of active vitamin D and calcium (relative risk [RR] = 6.5, 95% CI 2.5–16.4, 385 more per 1000 patients, high certainty). PTH therapy may increase hypercalcemia (RR =2.4, 95% CI 1.2–5.04, low certainty). The findings may support the use of PTH therapy in patients with chronic hypoparathyroidism. Because of limitations of short duration and small sample size, evidence from randomized trials is limited regarding important benefits of PTH therapy compared with conventional therapy. Establishing such benefits will require further studies. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Management of Hypoparathyroidism

“…Two systematic reviews informed the recommendations provided in this document: a survey of panel practice ( 5 ) and a review of randomized trials of PTH versus conventional therapy in patients with HypoPT. ( 6 )…”

“…Many of the case reports describing the need for higher supplementation of active vitamin D analogue did not report if Reproduced with permission from Yao and colleagues. (6) MID = minimally important difference.…”

Hypoparathyroidism: update of guidelines from the 2022 International Task Force

“…PTH replacement therapy should be considered in patients who are not adequately controlled on conventional therapy. Inadequate control is considered to be defined when any one of the following are present despite maximal effort with conventional therapy: symptomatic hypocalcemia, hyperphosphatemia, renal insufficiency, hypercalciuria, or poor quality of life (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31).…”

The Fifth International Workshop on the Evaluation and Management of Primary Hyperparathyroidism

“…The reports on hypoparathyroidism are published in a contiguous issue of JBMR. (22)(23)(24)(25)(26)(27)(28) In the commentary introducing those reports, we gratefully acknowledge those who were involved in that major effort. (29) Ever mindful of this international effort, we have reached out to many organizations, societies, and patient advocacy groups.…”

“…The reports on hypoparathyroidism are published in a contiguous issue of JBMR . ( 22‐28 ) In the commentary introducing those reports, we gratefully acknowledge those who were involved in that major effort. ( 29) …”