Therapy of secondary hyperparathyroidism with 19-nor -1α, 25- dihydroxyvitamin D2

K. J. Martin, E. A. Gonzalez, M. E. Gellens, L. L. Hamm, H. Abboud, J. Lindberg

Research output: Contribution to journalArticlepeer-review

72 Scopus citations

Abstract

Secondary hyperparathyroidism contributes to significant morbidity in patients with chronic renal failure. The treatment of this disorder with vitamin D compounds, such as calcitriol, although effective at suppressing parathyroid hormone (PTH) secretion, may promote the development of hypercalcemia and hyperphosphatemia, thus increasing the risk for metastatic calcification. A new vitamin D analogue, 19-nor-1α,25-(OH)2D2 (paricalcitol; Zemplar, Abbott Laboratories, Inc, Chicago, IL) has recently been developed for the treatment of secondary hyperparathyroidism, and, in experimental animals, it was found to be less calcemic and phosphatemic than calcitriol. In double-blind clinical trials, paricalcitol effectively decreased the levels of PTH by 60%, yet the mean serum calcium values remained within the normal range. The few episodes of hypercalcemia that occurred in the paricalcitol-treated patients (8 of 400 determinations ≥11.0 mg/dL in 7 patients) were associated with marked decreases in PTH levels (87% ± 2% less than baseline) and absolute values of PTH less than 100 pg/mL in four of the seven patients. PTH values less than 100 pg/mL, however, occurred in 15 patients, but were not invariably associated with frank hypercalcemia, although serum calcium levels increased to 10.3 ± 0.3 mg/dL, slightly greater than the upper limits of normal. Additional studies to evaluate the conversion from calcitriol to paricalcitol therapy showed that a (lose ratio of 1:4 (calcitriol:paricalcitol) could maintain control of high levels of PTH without significant alterations in serum calcium and phosphorus levels. These studies indicate that effective control of hyperparathyroidism can be achieved with paricalcitol therapy with minimal perturbation of serum calcium and phosphorus levels, and may have a therapeutic advantage over current treatment strategies.

Original languageEnglish (US)
Pages (from-to)S61-S66
JournalAmerican Journal of Kidney Diseases
Volume32
Issue number4 SUPPL. 2
StatePublished - Jan 1 1998
Externally publishedYes

Keywords

  • Calcitrol analogues
  • Hyperparathyroidism
  • Vitamin D

ASJC Scopus subject areas

  • Nephrology

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