[Low-dose cinacalcet reduces serum calcium in patients with primary hyperparathyroidism not eligible for surgery]. / Dosis bajas de cinacalcet reducen el calcio sérico en pacientes con hiperparatiroidismo primario no subsidiario de tratamiento quirúrgico.

We present our experience with low-dose cinacalcet to normalize serum calcium in patients with primary hyperparathyroidism (PHPT) not eligible for surgery. We analyzed the impact of this drug on various parameters of calcium-phosphorus metabolism and its tolerability profile. We recruited 17 patients diagnosed with PHPT who had hypercalcemia and also met one or more of the following inclusion criteria: elevated risk for parathyroidectomy, persistent/recurrent PHPT after previous parathyroid surgery or refusal to undergo surgery. The starting dose of cinacalcet was 30 or 60 mg/day, which was adjusted depending on the degree of calcemia reduction and tolerance to the drug. We observed a reduction in serum calcium that was already evident in the first post-treatment test. Appropriate dose adjustment was performed when required and normal serum calcium levels were achieved in most patients, remaining stable during follow-up. Parathyroid hormone was reduced but not normalized in most patients. Calciuria decreased while serum phosphate and alkaline phosphatase levels increased. Cinacalcet tolerance was generally good at the doses used. The most common adverse effects were weakness, dizziness and asthenia, leading to treatment withdrawal in only one patient. We conclude that low-dose cinacalcet reduces serum calcium efficiently, normalizes calcium levels in most patients with PHPT not eligible for surgical treatment and has a good tolerability profile.

Dosis bajas de cinacalcet reducen el calcio sérico en pacientes con hiperparatiroidismo primario no subsidiario de tratamiento quirúrgico / Low-dose cinacalcet reduces serum calcium in patients with primary hyperparathyroidism not eligible for surgery

Presentamos nuestra experiencia con cinacalcet a dosis bajas, en pacientes con hiperparatiroidismo primario (HPTP) no subsidiario de tratamiento quirúrgico con el objetivo principal de normalizar la calcemia. Analizamos el impacto del fármaco sobre diversos parámetros del metabolismo calcio-fósforo y su perfil de tolerancia. Reclutamos un total de 17 pacientes diagnosticados de HPTP que presentaban hipercalcemia y que reunían además alguno de los siguientes criterios de inclusión: riesgo elevado para paratiroidectomía, HPTP persistente/recurrente tras cirugía paratiroidea previa o rechazo del paciente a la intervención quirúrgica. La dosis inicial de cinacalcet fue de 30 o 60mg/día, la cual se ajustó en función del grado de reducción de la calcemia y la tolerancia al fármaco. Observamos una reducción del calcio sérico que ya resultaba evidente en el primer control postratamiento. Tras el ajuste pertinente de dosis cuando fue preciso, se consiguió normalizar la calcemia en una mayoría de los pacientes, la cual se mantuvo estable a lo largo del seguimiento. La PTH se redujo, aunque no se normalizó en la mayor parte de los pacientes. La calciuria descendió mientras que la fosforemia y la fosfatasa alcalina sérica aumentaron. La tolerancia a cinacalcet fue buena en general a las dosis utilizadas. Los efectos secundarios más frecuentes fueron debilidad, mareos y astenia, y solamente en un paciente motivaron la suspensión del tratamiento. Concluimos que cinacalcet a dosis bajas reduce la calcemia de forma eficaz y consigue una normalización de la misma en una mayoría de pacientes con HPTP no subsidiarios de tratamiento quirúrgico con un buen perfil de tolerancia al fármaco (AU)

We present our experience with low-dose cinacalcet to normalize serum calcium in patients with primary hyperparathyroidism (PHPT) not eligible for surgery. We analyzed the impact of this drug on various parameters of calcium-phosphorus metabolism and its tolerability profile We recruited 17 patients diagnosed with PHPT who had hypercalcemia and also met one or more of the following inclusion criteria: elevated risk for parathyroidectomy, persistent/recurrent PHPT after previous parathyroid surgery or refusal to undergo surgery. The starting dose of cinacalcet was 30 or 60mg/day, which was adjusted depending on the degree of calcemia reduction and tolerance to the drug.We observed a reduction in serum calcium that was already evident in the first post-treatment test. Appropriate dose adjustment was performed when required and normal serum calcium levels were achieved in most patients, remaining stable during follow-up. Parathyroid hormone was reduced but not normalized in most patients. Calciuria decreased while serum phosphate and alkaline phosphatase levels increased. Cinacalcet tolerance was generally good at the doses used. The most common adverse effects were weakness, dizziness and asthenia, leading to treatment withdrawal in only one patient. We conclude that low-dose cinacalcet reduces serum calcium efficiently, normalizes calcium levels in most patients with PHPT not eligible for surgical treatment and has a good tolerability profile (AU)