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The role of calcimimetics in the treatment of hyperparathyroidism.
Eur J Clin Invest. 2007 Dec; 37(12):915-22.EJ

Abstract

Calcimimetics reduce serum levels of parathyroid hormone (PTH) and calcium, with a leftward shift in the set-point for calcium-regulated PTH secretion. The aim of this publication is to review the data available for calcimimetics in primary, secondary and tertiary hyperparathyroidism (HPT). Parathyroidectomy (PTX) is currently the only curative treatment for primary HPT, and recommended for patients with moderate-to-severe disease, as defined by a 2002 National Institute's of Health summary statement. In general, patients with primary HPT not meeting these surgical criteria, as well as those with contraindication or refusal for surgery, are monitored for signs and symptoms of primary HPT. There are currently no non-surgical therapies approved for use in primary HPT, although bisphosphonates are used in some patients, in an effort to control serum calcium levels. Calcimimetics decrease PTH and calcium levels and are a potential alternative for patients contraindicated for PTX, or who have failed previous PTX and have recurrent primary HPT. Secondary HPT develops early in chronic kidney disease and is present virtually in all patients with end-stage renal disease (ESRD). Secondary HPT is a progressive disease and is associated with several systemic complications, including renal osteodystrophy, soft tissue and vascular calcifications, and adverse cardiovascular outcomes. In ESRD patients, calcimimetics were shown to simultaneously reduce PTH, calcium, phosphate and calcium x phosphate product. In addition, observational analyses of use of calcimimetics in the ESRD population have shown a reduction of important clinical outcomes. In renal allograft recipients with tertiary HPT and hypercalcaemia, calcimimetics are a promising treatment option to control the parameters of calcium phosphate metabolism and may be a valid alternative to PTX. Based on its unique mechanism of action, the calcimimetic cinacalcet may play a role in the medical treatment of primary and tertiary forms of HPT, in addition to the registered indication for the treatment of secondary HPT.

Authors+Show Affiliations

Clinic for Nephrology, University Hospital of Zürich, Switzerland. rudolf.wuethrich@usz.chNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

18036025

Citation

Wüthrich, R P., et al. "The Role of Calcimimetics in the Treatment of Hyperparathyroidism." European Journal of Clinical Investigation, vol. 37, no. 12, 2007, pp. 915-22.
Wüthrich RP, Martin D, Bilezikian JP. The role of calcimimetics in the treatment of hyperparathyroidism. Eur J Clin Invest. 2007;37(12):915-22.
Wüthrich, R. P., Martin, D., & Bilezikian, J. P. (2007). The role of calcimimetics in the treatment of hyperparathyroidism. European Journal of Clinical Investigation, 37(12), 915-22.
Wüthrich RP, Martin D, Bilezikian JP. The Role of Calcimimetics in the Treatment of Hyperparathyroidism. Eur J Clin Invest. 2007;37(12):915-22. PubMed PMID: 18036025.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The role of calcimimetics in the treatment of hyperparathyroidism. AU - Wüthrich,R P, AU - Martin,D, AU - Bilezikian,J P, PY - 2007/11/27/pubmed PY - 2008/3/22/medline PY - 2007/11/27/entrez SP - 915 EP - 22 JF - European journal of clinical investigation JO - Eur J Clin Invest VL - 37 IS - 12 N2 - Calcimimetics reduce serum levels of parathyroid hormone (PTH) and calcium, with a leftward shift in the set-point for calcium-regulated PTH secretion. The aim of this publication is to review the data available for calcimimetics in primary, secondary and tertiary hyperparathyroidism (HPT). Parathyroidectomy (PTX) is currently the only curative treatment for primary HPT, and recommended for patients with moderate-to-severe disease, as defined by a 2002 National Institute's of Health summary statement. In general, patients with primary HPT not meeting these surgical criteria, as well as those with contraindication or refusal for surgery, are monitored for signs and symptoms of primary HPT. There are currently no non-surgical therapies approved for use in primary HPT, although bisphosphonates are used in some patients, in an effort to control serum calcium levels. Calcimimetics decrease PTH and calcium levels and are a potential alternative for patients contraindicated for PTX, or who have failed previous PTX and have recurrent primary HPT. Secondary HPT develops early in chronic kidney disease and is present virtually in all patients with end-stage renal disease (ESRD). Secondary HPT is a progressive disease and is associated with several systemic complications, including renal osteodystrophy, soft tissue and vascular calcifications, and adverse cardiovascular outcomes. In ESRD patients, calcimimetics were shown to simultaneously reduce PTH, calcium, phosphate and calcium x phosphate product. In addition, observational analyses of use of calcimimetics in the ESRD population have shown a reduction of important clinical outcomes. In renal allograft recipients with tertiary HPT and hypercalcaemia, calcimimetics are a promising treatment option to control the parameters of calcium phosphate metabolism and may be a valid alternative to PTX. Based on its unique mechanism of action, the calcimimetic cinacalcet may play a role in the medical treatment of primary and tertiary forms of HPT, in addition to the registered indication for the treatment of secondary HPT. SN - 0014-2972 UR - https://www.unboundmedicine.com/medline/citation/18036025/The_role_of_calcimimetics_in_the_treatment_of_hyperparathyroidism_ L2 - https://doi.org/10.1111/j.1365-2362.2007.01874.x DB - PRIME DP - Unbound Medicine ER -