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A study of maintenance therapy after intravenous maxacalcitol for secondary hyperparathyroidism.

AbstractAIM:
Intravenous vitamin D therapy is an established treatment for secondary hyperparathyroidism (SHPT). However, no protocols have been established for maintenance therapy with intravenous or oral vitamin D after control of intact parathyroid hormone (iPTH) within the target range.
METHODS:
Step I. For patients with SHPT (200 ≤ iPTH ≤ 500 pg/ml), a dose of 2.5 mg maxacalcitol (OCT) was administered intravenously three times a week with oral sevelamer hydrochloride; the dose was increased to a 10 µg maximum three times a week to control iPTH to < 150 pg/ml. Step II. When iPTH reached the target level, patients were assigned to Group A (oral alfacalcidol 1.0 µg/day) or B (oral alfacalcidol 0.25 µg/ day). Serum iPTH, calcium, and inorganic phosphorus were measured each month for 6 months. Maintenance rates for the target iPTH levels were evaluated, < 150 pg/ml at Step I and < 200 pg/ml at Step II.
RESULTS:
iPTH decreased to < 150 pg/ml by OCT in 24 of 35 patients (68.6%). During the 24-week observation period, iPTH was controlled for 83.3% patients in Group A vs. 36.4% for Group B (p < 0.05). No dropouts due to hypercalcemia or hyperphosphatemia occurred.
CONCLUSION:
OCT dose titration was effective for SHPT. A higher daily dose of oral alfacalcidol (1.0 µg) appears to be more effective than a lower dose (0.25 µg) as maintenance therapy after iPTH control.
AuthorsM Adachi, T Miyoshi, N Shiraishi, H Shimada, S Sakaguchi, K Tomita, K Kitamura
JournalClinical nephrology (Clin Nephrol) Vol. 76 Issue 4 Pg. 266-72 (Oct 2011) ISSN: 0301-0430 [Print] Germany
PMID21955861 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Biomarkers
  • Bone Density Conservation Agents
  • Polyamines
  • Sevelamer
  • Calcitriol
  • maxacalcitol
Topics
  • Administration, Oral
  • Aged
  • Biomarkers (blood)
  • Bone Density Conservation Agents (administration & dosage, therapeutic use)
  • Calcitriol (administration & dosage, analogs & derivatives, therapeutic use)
  • Female
  • Humans
  • Hyperparathyroidism, Secondary (drug therapy)
  • Infusions, Intravenous
  • Male
  • Polyamines (administration & dosage, therapeutic use)
  • Prospective Studies
  • Renal Dialysis
  • Sevelamer
  • Statistics, Nonparametric
  • Treatment Outcome

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