Endocrine Abstracts

Background: In the UK, 1 to 4 per 1000 people have primary hyperparathyroidism (PHPT) and are at risk of hypercalcaemia and its complications. Whilst surgery is the only curative option in the management of PHPT, several patients are managed conservatively or medically. Cinacalcet (a calcimimetic) has a role in PHPT management, in those who have declined or are unable to progress to surgery. It is important that the use of Cinacalcet in these cases adheres to the guidelines for optimal patient management i.e. when adjusted calcium levels (aCa) are >3.00mmol/l or between 2.85-3.00mmol/l with hypercalcemia related symptoms.

Aims: To compare the QEH Birmingham practice to the NICE guideline [NG132] for prescribing cinacalcet and to also compare aCa before and after cinacalcet treatment.

Method: In this retrospective study, we collected demographic, biochemistry, clinical and prescribing data, using a structured proforma, from patients who were prescribed cinacalcet from the QEH Birmingham for PHPT.

Results: Of the 46 patients included, 27 were prescribed cinacalcet after [NG132] was published. 19 of these patients (70%), were prescribed cinacalcet in accordance with the guideline. The post-treatment aCa target for patients started on cinacalcet is 2.60mmol/l and only 20 out of 46 patients (43%) met this, over the study follow-up time. Overall, there was a reduction in aCa(mmol/l) when comparing before (Mean 3.01, 95%CI 2.95-3.07) and after treatment (Mean 2.66, 95%CI 2.57-2.75).

Conclusion: We showed that the cinacalcet was prescribed in accordance with the NG132 guideline in the majority of cases. Prescribing within the trust is structured and limited to patients seen by a specialist team. Structured prescribing checklists are completed to ensure that prescribing is rationalised. Reasons for prescribing outside of the guidelines may be due to hypercalcaemia following multiple failed surgeries, or to use cinacalcet as bridging therapy before elective surgery.