Clinical outcomes of parathyroidectomy versus cinacalcet in the clinical management of secondary hyperparathyroidism

Won Woong Kim, Yumie Rhee, Beom Seok Kim, Kwangsoon Kim, Cho Rok Lee, Sang Wook Kang, Jandee Lee, Jong Ju Jeong, Kee Hyun Nam, Woong Youn Chung

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Abstract

Parathyroidectomy (PTX) is the standard treatment for secondary hyperparathyroidism (SHPT); however, the administration of cinacalcet has gained prominence as a noninvasive treatment. We aimed to determine whether PTX or cinacalcet is more effective in preventing morbidity and mortality through reviewing follow-up data concerning surgical management of SHPT. We retrospectively analyzed and divided 209 patients with SHPT into two treatment groups: PTX (n = 78) and cinacalcet (n = 131) groups. We compared clinical features, the over-the-target range rate during pre- and postintervention periods, new cardiovascular events, and all-cause mortality between both groups. Almost all biochemical parameters were well controlled in the post-intervention period, and were within the recommended target range for the PTX group but not for the cinacalcet group. A significant difference was observed in the over-the-target range rate during the postintervention period between the groups. PTX and cinacalcet interventions significantly lowered the over-the-target range rates for serum intact parathyroid hormone (iPTH) (>300 pg/mL), corrected calcium (>10.5 mg/mL), serum phosphorus (>5.5 mg/ dL), and calcium-phosphorus product (>55) in both groups (p = 0.001). PTX reduced the risk of new cardiovascular events by 86% compared to cinacalcet (p = 0.001); however, all-cause mortality did not differ significantly (14.1% vs. 7.6%, p = 0.132). For patients with SHPT, PTX helps prevent cardiovascular events through normalizing biochemical variables, according to recommended guidelines. PTX should be considered before cinacalcet treatment to prevent new cardiovascular events. Early PTX for appropriate patients can help prevent immediate postoperative complications and mortality.

Original languageEnglish
Pages (from-to)881-889
Number of pages9
JournalEndocrine Journal
Volume66
Issue number10
DOIs
Publication statusPublished - 2019 Jan 1

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All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Kim, W. W., Rhee, Y., Kim, B. S., Kim, K., Lee, C. R., Kang, S. W., Lee, J., Jeong, J. J., Nam, K. H., & Chung, W. Y. (2019). Clinical outcomes of parathyroidectomy versus cinacalcet in the clinical management of secondary hyperparathyroidism. Endocrine Journal, 66(10), 881-889. https://doi.org/10.1507/endocrj.EJ19-0036