Cinacalcet hydrochloride: calcimimetic for the treatment of hyperparathyroidism

Mineral metabolism disorders, including those related to secondary hyperparathyroidism, affect a large number of patients with chronic kidney disease and are associated with increased relative risk of morbidity and mortality in hemodialysis patients. The traditional therapy of secondary hyperparathyroidism based on vitamin D compounds and calcium-based phosphate binders is often limited by the increase of serum calcium and phosphorus levels limiting the dose that can be given safely, and thus, preventing the attainment of treatment targets. Cinacalcet hydrochloride (Sensipar®, Mimpara®, Parareg®) is the first in a new class of therapeutic agents, the calcimimetics, that increase the sensitivity of calcium-sensing receptors to the extracellular calcium ions, thus lowering parathyroid hormone production and release, decreasing serum calcium and phosphorous concentrations simultaneously. Different randomized, double-blind, placebo-controlled trials evaluated the safety and ability of cinacalcet hydrochloride treatment to improve achievement of target levels of parathyroid hormone, calcium, phosphorus and calcium phosphorus product in dialysis patients. Cinacalcet hydrochloride has also demonstrated to be effective in reducing parathyroid hormone and serum calcium concentrations in patients with primary hyperparathyroidism. On the basis of available data, calcimimetics represent an important innovation and will change the management of mineral metabolism disorders in patients with chronic kidney disease and primary hyperparathyroidism.