Cinacalcet appears to improve biochemical parameters in patients with secondary hyperparathyroidism (SHPT), but it does not reduce all-cause and cardiovascular mortality, according to new study findings.
In a meta-analysis of 21 randomized controlled trials, cinacalcet, a calcimimetic, significantly reduced serum parathyroid hormone (PTH) levels by a mean difference of −259.24 pg/mL, calcium by a mean difference of −0.92 mg/dL, and calcium-phosphorus product by a mean difference of -5.97 mg2/dL2 compared with control treatment (typically placebo, but some studies included active treatments such as vitamin D therapy). The results were consistent in patients receiving and not receiving dialysis, in patients older and younger than 55 years, in studies with sample sizes larger or smaller than 200, in trials shorter or longer than 24 weeks, and among trials inside and outside the United States.
But cinacalcet did not significantly decrease the risk for all-cause or cardiovascular mortality in patients with chronic kidney disease (CKD) or end-stage kidney disease (ESKD), Li Yao, MD, of the First Hospital of China Medical University in Liaoning, China, and colleagues reported in BMC Nephrology.
Furthermore, cinacalcet was significantly associated with a higher incidence of certain adverse events. Both nausea and vomiting were twice as often among cinacalcet than control recipients. The rate of hypocalcemia was 10-fold higher among cinacalcet users.
The findings corroborate results from similar meta-analyses comparing cinacalcet with control groups, according to the investigators.
Sun Y, Tian B, Sheng Z, Wan P, Xu T, Yao L. Efficacy and safety of cinacalcet compared with other treatments for secondary hyperparathyroidism in patients with chronic kidney disease or end-stage renal disease: a meta-analysis. BMC Nephrol. 21:316. doi:10.1186/s12882-019-1639-9