A study of maintenance therapy after intravenous maxacalcitol for secondary hyperparathyroidism

作者：Adachi M^*; Miyoshi T; Shiraishi N; Shimada H; Sakaguchi S; Tomita K; Kitamura K

来源：Clinical Nephrology, 2011, 76(4): 266-272.

DOI：10.5414/CN106595

• secondary hyperparathyroidism
• maxacalcitol
• maintenance therapy
• alfacalcidol

Aim: 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 mu g maxacalcitol (OCT) was administered intravenously three times a week with oral sevelamer hydrochloride; the dose was increased to a 10 mu g 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 mu g/d) or B (oral alfacalcidol 0.25 mu g/d). 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 mu g) appears to be more effective than a lower dose (0.25 mu g) as maintenance therapy after iPTH control.

• 出版日期2011-10