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Therapy of secondary hyperparathyroidism with 19-nor-1alpha,25-dihydroxyvitamin D2.
Am J Kidney Dis. 1998 Oct; 32(2 Suppl 2):S61-6.AJ

Abstract

Secondary hyperparathyroidism contributes to significant morbidity in patients with chronic renal failure. The treatment of this disorder with vitamin D compounds, such as calcitriol, although effective at suppressing parathyroid hormone (PTH) secretion, may promote the development of hypercalcemia and hyperphosphatemia, thus increasing the risk for metastatic calcification. A new vitamin D analogue, 19-nor-1alpha,25-(OH)2D2 (paricalcitol; Zemplar, Abbott Laboratories, Inc, Chicago, IL) has recently been developed for the treatment of secondary hyperparathyroidism, and, in experimental animals, it was found to be less calcemic and phosphatemic than calcitriol. In double-blind clinical trials, paricalcitol effectively decreased the levels of PTH by 60%, yet the mean serum calcium values remained within the normal range. The few episodes of hypercalcemia that occurred in the paricalcitol-treated patients (8 of 400 determinations > or =11.0 mg/dL in 7 patients) were associated with marked decreases in PTH levels (87% +/- 2% less than baseline) and absolute values of PTH less than 100 pg/mL in four of the seven patients. PTH values less than 100 pg/mL, however, occurred in 15 patients, but were not invariably associated with frank hypercalcemia, although serum calcium levels increased to 10.63 +/- 0.3 mg/dL, slightly greater than the upper limits of normal. Additional studies to evaluate the conversion from calcitriol to paricalcitol therapy showed that a dose ratio of 1:4 (calcitriol:paricalcitol) could maintain control of high levels of PTH without significant alterations in serum calcium and phosphorus levels. These studies indicate that effective control of hyperparathyroidism can be achieved with paricalcitol therapy with minimal perturbation of serum calcium and phosphorus levels, and may have a therapeutic advantage over current treatment strategies.

Authors+Show Affiliations

Division of Nephrology, Saint Louis University, MO, USA. martinkj@wpogate.slu.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

9808145

Citation

Martin, K J., et al. "Therapy of Secondary Hyperparathyroidism With 19-nor-1alpha,25-dihydroxyvitamin D2." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 32, no. 2 Suppl 2, 1998, pp. S61-6.
Martin KJ, González EA, Gellens ME, et al. Therapy of secondary hyperparathyroidism with 19-nor-1alpha,25-dihydroxyvitamin D2. Am J Kidney Dis. 1998;32(2 Suppl 2):S61-6.
Martin, K. J., González, E. A., Gellens, M. E., Hamm, L. L., Abboud, H., & Lindberg, J. (1998). Therapy of secondary hyperparathyroidism with 19-nor-1alpha,25-dihydroxyvitamin D2. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 32(2 Suppl 2), S61-6.
Martin KJ, et al. Therapy of Secondary Hyperparathyroidism With 19-nor-1alpha,25-dihydroxyvitamin D2. Am J Kidney Dis. 1998;32(2 Suppl 2):S61-6. PubMed PMID: 9808145.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Therapy of secondary hyperparathyroidism with 19-nor-1alpha,25-dihydroxyvitamin D2. AU - Martin,K J, AU - González,E A, AU - Gellens,M E, AU - Hamm,L L, AU - Abboud,H, AU - Lindberg,J, PY - 1998/11/10/pubmed PY - 1998/11/10/medline PY - 1998/11/10/entrez SP - S61 EP - 6 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 32 IS - 2 Suppl 2 N2 - Secondary hyperparathyroidism contributes to significant morbidity in patients with chronic renal failure. The treatment of this disorder with vitamin D compounds, such as calcitriol, although effective at suppressing parathyroid hormone (PTH) secretion, may promote the development of hypercalcemia and hyperphosphatemia, thus increasing the risk for metastatic calcification. A new vitamin D analogue, 19-nor-1alpha,25-(OH)2D2 (paricalcitol; Zemplar, Abbott Laboratories, Inc, Chicago, IL) has recently been developed for the treatment of secondary hyperparathyroidism, and, in experimental animals, it was found to be less calcemic and phosphatemic than calcitriol. In double-blind clinical trials, paricalcitol effectively decreased the levels of PTH by 60%, yet the mean serum calcium values remained within the normal range. The few episodes of hypercalcemia that occurred in the paricalcitol-treated patients (8 of 400 determinations > or =11.0 mg/dL in 7 patients) were associated with marked decreases in PTH levels (87% +/- 2% less than baseline) and absolute values of PTH less than 100 pg/mL in four of the seven patients. PTH values less than 100 pg/mL, however, occurred in 15 patients, but were not invariably associated with frank hypercalcemia, although serum calcium levels increased to 10.63 +/- 0.3 mg/dL, slightly greater than the upper limits of normal. Additional studies to evaluate the conversion from calcitriol to paricalcitol therapy showed that a dose ratio of 1:4 (calcitriol:paricalcitol) could maintain control of high levels of PTH without significant alterations in serum calcium and phosphorus levels. These studies indicate that effective control of hyperparathyroidism can be achieved with paricalcitol therapy with minimal perturbation of serum calcium and phosphorus levels, and may have a therapeutic advantage over current treatment strategies. SN - 0272-6386 UR - https://www.unboundmedicine.com/medline/citation/9808145/Therapy_of_secondary_hyperparathyroidism_with_19_nor_1alpha25_dihydroxyvitamin_D2_ L2 - https://www.lens.org/lens/search/patent/list?q=citation_id:9808145 DB - PRIME DP - Unbound Medicine ER -