Intermittent Dosing of Cinacalcet is also Effective in Treating Secondary Hyperparathyroidism in Hemodialysis Patients

Abdullah Khalaf Al-Hwiesh
2013 Pharmaceutica Analytica Acta  
The calcimimetic, cinacalcet hydrochloride acting on the calcium-sensing receptors is being used quite often in the management of secondary hyperparathyroidism (SHPT). It is given in daily dose of 30-180 mg but there have not been enough comparative trials with intermittent dosing schedule. Aim: To evaluate effectiveness of daily cinacalcet hydrochloride dose and its 3 weekly doses in reducing serum intact PTH levels and relative concentrations of calcium and phosphorous in patients with end
more » ... ge renal diseases (ESRD) with SHPT on maintenance hemodialysis (HD). Material and methods: Chronic kidney disease (CKD) patients (n=29) who were receiving daily dose (OD) of cinacalcet for SHPT for I year were shifted to an intermittent dosing regimen of cinacalcet at the end of each hemodialysis session (HD), 3 times per week (study patients). After taking baseline measurements of PTH, its monthly assessment along with serum calcium, phosphorous and alkaline phosphatase level estimations at 1, 3, 6, 9 and 12 months were then compared with the baseline levels. Results: Overall the mean intact PTH value was 174.2 + 16.8 pg/ml at the end of one year treatment prior to the study, while receiving a mean dose of 83.7 ± 11 mg cinacalcet OD. This controlled value of PTH did not show any statistically significant difference over the next 12 months when the study patients were given intermittent dosing (3/ week) at the end of each hemodialysis session. Similarly the calcium values did not change to a significant level in the study subjects, although the serum phosphorus showed a significant rise at the end of the study period (p=0.003). Conclusion: Cinacalcet effectively controls parathyroid hormone levels and uncontrolled secondary hyperparathyroidism both when given daily and intermittently (3/week). Frequent monitoring and adequate replacement with calcium and vitamin D sterols prevent hypocalcemia with cinacalcet therapy. Thus intermittent dosing of cinacalcet is an excellent cost-effective therapeutic option in HD patients with SHPT. In addition, it improves drug compliance.
doi:10.4172/2153-2435.1000229 fatcat:f5otiwcg4vaalka6bcunsuwvem