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The Use of Calcimimetics for the Treatment of Secondary Hyperparathyroidism: A 10 Year Evidence Review
Author(s) -
Rodríguez Mariano,
Goodman William G.,
Liakopoulos Vassilios,
Messa Piergiorgio,
Wiecek Andrzej,
Cunningham John
Publication year - 2015
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12357
Subject(s) - calcimimetic , secondary hyperparathyroidism , medicine , calcium sensing receptor , cinacalcet , parathyroid hormone , hyperparathyroidism , primary hyperparathyroidism , parathyroidectomy , endocrinology , parathyroid chief cell , parathyroid gland , urology , calcium
Abstract Until the discovery of calcimimetics, the management of secondary hyperparathyroidism ( SHPT ) relied exclusively on treatment with phosphate binders, vitamin D derivatives or surgical parathyroidectomy with limited success. The therapeutic use of calcimimetic agents, together with a better understanding of the pivotal role of the calcium‐sensing receptor (Ca SR ) in the physiological regulation of parathyroid gland function, substantially advanced the management of hyperparathyroidism in dialysis practice. Calcimimetics bind selectively to the Ca SR receptor in parathyroid tissue and enhance the inhibitory effect of extracellular calcium ions on parathyroid hormone ( PTH ) secretion, thereby reducing PTH levels even when serum calcium concentrations are normal or low. The availability of calcimimetic agents for clinical use has opened a new era in the management of patients with SHPT . Indeed, calcimimetic compounds have been shown to reduce PTH levels and to lower serum calcium concentrations in all forms of hyperparathyroidism, including primary hyperparathyroidism ( PHPT ) and parathyroid carcinoma. Such findings underscore the critical importance of the Ca SR as a therapeutic target in this family of clinical disorders. New calcimimetic agents are being developed that have the potential to offer improved efficacy and safety compared with currently available calcimimetic compounds.