Cinacalcet in the management of primary hyperparathyroidism: Post marketing experience of an Italian multicentre group

Federica Saponaro, Antongiulio Faggiano, Franco Grimaldi, Giorgio Borretta, Maria Luisa Brandi, Salvatore Minisola, Andrea Frasoldati, Enrico Papini, Alfredo Scillitani, Chiara Banti, Michela Del Prete, Fabio Vescini, Laura Gianotti, Loredana Cavalli, Elisabetta Romagnoli, Annamaria Colao, Filomena Cetani, Claudio Marcocci

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Abstract

Objective To report the Italian experience on cinacalcet use following its approval by the European Medical Agency (EMA) to control hypercalcaemia in patients with primary hyperparathyroidism (PHPT). Design Retrospective data collection from 100 patients with sporadic (sPHPT) and 35 with familial PHPT (fPHPT) followed in eight Italian centres between October 2008 and March 2011. Measurements Albumin-adjusted serum calcium, PTH, 25OHD, daily cinacalcet dose and adverse events were recorded during the follow-up (1-46 months). Results Baseline serum calcium was 2·90 ± 0·27 nmol/l in sPHPT and 2·75 ± 0·17 nmol/l in fPHPT patients (P = 0·007). The cinacalcet EMA labelling was met in 53% sPHPT and 26% fPHPT patients. High surgical risk (34%), negative preoperative imaging (19%), control of hypercalcaemia before parathyroidectomy (PTx) (24%), and refusal of PTx (19%) accounted for cinacalcet prescription in 96% of sPHPT patients. Conversely, initial treatment (34%), persistent/relapsing PHPT after surgery (31%), and refusal of PTx (14%) were the indications in 79% fPHPT patients. Cinacalcet was started at 30 mg/daily in 64% of sPHPT and 91% of fPHPT and increased until normocalcaemia was reached or side effects occurred. The final daily dose ranged between 15 and 120 mg. The majority of patients (65% of sPHPT and 80% of fPHPT) become normocalcaemic. Treatment was withdrawn in six patients because of side effects. Conclusions There is a wide heterogeneity in the prescription of cinacalcet in PHPT patients in Italy and the EMA labelling is not always followed, particularly in fPHPT patients. Cinacalcet effectively reduces serum calcium in patients with either sPHPT or fPHPT.

Original languageEnglish
Pages (from-to)20-26
Number of pages7
JournalClinical Endocrinology
Volume79
Issue number1
DOIs
Publication statusPublished - Jul 2013

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ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

Saponaro, F., Faggiano, A., Grimaldi, F., Borretta, G., Brandi, M. L., Minisola, S., Frasoldati, A., Papini, E., Scillitani, A., Banti, C., Prete, M. D., Vescini, F., Gianotti, L., Cavalli, L., Romagnoli, E., Colao, A., Cetani, F., & Marcocci, C. (2013). Cinacalcet in the management of primary hyperparathyroidism: Post marketing experience of an Italian multicentre group. Clinical Endocrinology, 79(1), 20-26. https://doi.org/10.1111/cen.12108