Endocrine Abstracts

Objectives

There is a paucity of real-world studies on the clinical burden and practice patterns associated with chronic hypoparathyroidism (cHP). This study assesses the comorbidities, treatment and lab testing patterns in cHP patients identified using surgery-based criteria.

Methods

This was a retrospective study conducted using a large (130 million individuals) US claims database (HealthVerity Closed Payer Claim Medical and Pharmacy database (Private Source 20) from Oct 2014 to Dec 2019. The patients were eligible if they had a procedure claim of either parathyroidectomy, complete or partial thyroidectomy, or neck dissection, followed by a HP diagnosis claim (6–15 months apart), with a subsequent second HP diagnosis claim at any time point. Patients also had to be continuously enrolled for 15 months before the index date (the date of the first qualifying HP diagnosis claim) and ≥6 months after. Patients were followed one year before the surgery and up to two years after the index date. Demographics, comorbidities, lab tests and treatment patterns were analyzed.

Results

1406 patients met the eligibility criteria and 1184 patients had complete data for 1-year follow-up. The mean age was 52.1 ± 16.4 (S.D.) years, and 83.2%were females. The mean time between surgery and qualifying HP diagnosis claim was 8.7 ± 2.3 (S.D.) months, and 115 patients (8.2%) had a HP diagnosis prior to surgery. During the 1-year follow-up, the most common comorbidities were cancer (54.2%, of which 49%were thyroid cancers), hypertension (49.7%), hypocalcemia (47.1%), chronic pulmonary disease (21.9%), diabetes (21.7%), cardiac arrhythmias (18.4%), CKD stage 3-5 (11.3%), osteoporosis (9.8%), and neuropsychiatric disorders, including anxiety (23.9%), depressive disorders (21.8%), and sleep-wake disorders (20.9%). Lab tests ordered during the 1-year follow-up included serum calcium (93.2%), eGFR/creatinine (86.2%), 25-Hydroxy Vitamin D (66.5%), intact PTH (63.0%), serum magnesium (40.9%), serum phosphorous (38.4%), bone mineral density (9.8%), and 24 h-urine calcium (8.4%). During the same period, 66.9%of patients had a prescription claim for thyroid replacement therapy, 51.6%for calcitriol, 13.3%for ergocalciferol, and 5.5%for PTH.

Conclusion

This large cohort of cHP patients, identified using surgery-based criteria, was recently diagnosed and had a substantial comorbidity burden that was aligned with the lab testing patterns. Already at this early stage of cHP, kidney function appears to be a key concern, and may be important when considering therapeutic intervention. These data are consistent with our findings from a larger cHP population identified in the same database using a diagnosis-based approach.