Use of one-alpha-hydroxyvitamin D2 (1alpha D2) in 121 hemodialysis patients with secondary hyperparathyroidism: A phase 3 trial.
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:573A 1997
Current treatment of the secondary hyperparathyroidism of renal failure depends largely on calcitriol. Either orally or parenterally various strategies have been devised in the use of this agent which binds to specific receptors on the parathyroid cell. Unfortunately, its action at other sites results in increases in calcium and phosphate and its effectiveness in suppressing PTH is limited by hypercalcemia, hyperphosphatemia and/or a high calcium x phosphate product. A number of new vitamin D metabolites, including 22-oxo, 19-nor, and 1-alpha-D2, have been described which appear to have much less effect at these other sites and therefore suppress PTH with much less risk of increasing calcium and phosphate levels. It is unclear how these agents do this, but different metabolism or variable binding to parathyroid, gut and bone receptors have been hypothesized.
In this report, the authors used 1-alpha-D2 orally and showed PTH suppression from about 900 to 250 pg/ml in about 16 weeks. This was accompanied by an increase in episodes of asymptomatic hypercalcemia (> 11.2 mg%) from 0.2 episodes/100 patient weeks to 3.7 episodes. Most such episodes were associated with PTH levels below the target range. Hyperphosphatemia (> 6.9 mg%) increased from 5 to 10.5 episodes/100 patient weeks. No other adverse events were noted.
Comment: In summary, this agent appears to fulfill the need for an agent that will suppress PTH with minimal effects on calcium and phosphate. We should anticipate eagerly its availability. (Donald Sherrard, M.D., University of Washington)
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ASN 30th Annual Meeting, San Antonio
CRF by problem area : Bone disease/aluminum