Immediate cinacalcet therapy may help improve calciphylaxis outcomes in patients with stage 4 to 5 chronic kidney disease (CKD) and calciphylaxis.
In a review of 26 case studies including 41 CKD patients published in the Australasian Journal of Dermatology, calciphylaxis lesions showed partial or complete response to cinacalcet monotherapy (83.4%) and combination therapy (82.8%). Cinacalcet combination therapy, however, proved superior to monotherapy for complete remission: 62.1% vs 41.7%. Combination therapy included the use of cinacalcet along with sodium thiosulfate, pamidronate, paricalcitol, corticosteroids, oxygen therapy, autologous growth factor spray, or autologous skin graft transplantation. The combination of cinacalcet and sodium thiosulfate had a treatment efficacy of 87.5%.
Intact parathyroid hormone (iPTH) levels fell by 1.6- and 2.3-fold in patients receiving cinacalcet monotherapy or combination therapy, respectively, over a period of 2 to 33 months. None of the studied patients had received cinacalcet, a calcimimetic, prior to calciphylaxis diagnosis. In most patients, calcium and phosphate parameters also stayed in range after cinacalcet therapy. The most common adverse events were gastrointestinal upset, anorexia, and hypocalcemia.
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Early diagnosis of calciphylaxis followed by prompt and consistent therapy including cinacalcet may help improve outcomes, according to authors Jacqueline Deen, MBBS, of Sunshine Coast University Hospital, Birtinya, and Helmut Schaider, MD, of Princess Alexandra Hospital, in Australia. The authors believe cinacalcet should be avoided or used cautiously in patients without secondary hyperparathyroidism (SHPT) due to the increased risk of developing adynamic bone disease.
“While no single, noninvasive therapy for calciphylaxis is 100% efficacious, there is an apparent place for cinacalcet in the treatment of this condition, particularly as an alternative to parathyroidectomy,” Drs Deen and Schaider concluded. “Noninvasive calciphylaxis management appears favourable, particularly in the context of an increasingly fragile and elderly chronic kidney disease population, often with multiple comorbidities, making them high-risk surgical candidates.”
A wide range of cinacalcet doses were used (25 to 300 mg/day). The authors urged future research to define the optimal use of cinacalcet in this setting.
Reference
Deen J and Schaider H. The use of cinacalcet for the treatment of calciphylaxis in patients with chronic kidney disease: A comprehensive review. Australasian J Derm. DOI:10.1111/ajd.12992
