Pierwotna nadczynność przytarczyc o niewielkim nasileniu — porównanie leczenia farmakologicznego i obserwacji klinicznej w ramach trwającego pięć lat badania klinicznego

Vera, Lara; Accornero, M; Dolcino, Mara; Oddo, Silvia; Giusti, Massimo

doi:10.5603/ep.2014.0063

Cited by 9 publications

(6 citation statements)

References 22 publications

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“…Two additional studies comparing surgical with medical treatment did not specify the time points of assessment of quality of life. 27 , 28 Therefore, they were not incorporated in our meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

Quality of Life After Surgery or Surveillance for Asymptomatic Primary Hyperparathyroidism

et al. 2015

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A number of studies have investigated the effects of surgery on symptoms and quality of life in patients with hyperparathyroidism. However, the results are inconsistent. We conducted this meta-analysis to quantitatively assess changes in quality of life among patients with asymptomatic primary hyperparathyroidism.Different databases were searched for randomized controlled trials comparing surgery with surveillance. Quality of life was measured by the Short Form-36 general health survey. The pooled random-effects estimates of standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated.Three trials involving 294 participants were included. At 1 year, patients undergoing parathyroidectomy had significantly better physical role functioning (SMD, 0.31; 95% CI 0.04–0.57; P = 0.02) and emotional role functioning (SMD, 0.29; 95% CI 0.02–0.55; P = 0.03). At 2 years, the surgery group had significantly better emotional role functioning (SMD, 0.35; 95% CI 0.02–0.67; P = 0.04) than the surveillance group. Furthermore, compared with baseline, emotional role functioning improved after surgery (SMD, 0.31; 95% CI 0.02–0.60; P = 0.04), whereas emotional role functioning tended to get worse in patients assigned to medical surveillance (SMD, −0.27; 95% CI −0.55 to 0.02; P = 0.07).Although Short Form-36 is a generic instrument, our results suggest that parathyroidectomy may be associated with better quality of life, especially in the emotional aspects of well-being.

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Section: Discussionmentioning

confidence: 99%

Quality of Life After Surgery or Surveillance for Asymptomatic Primary Hyperparathyroidism

et al. 2015

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“…Only two out of the three (45, 47) reports on s-calcium which is unchanged in one and decreases in the other during treatment, PTH, CTX, and alkaline phosphatase are reported to decline. Vera et al (47) reports a small and insignificant decline in BMD, whereas Yeh et al and Segula et al (45, 48) in accordance with most other studies report an increase at spine and hip. The prior study also reports a markedly increased risk of fractures compared to patients treated surgically (PTX) as well as controls, but the bisphosphonate subgroup also did have a much lower BMD at baseline compared to the other two groups.…”

Section: Resultsmentioning

confidence: 98%

“…The articles reporting on effects of etidronate, risedronate, and neridronate used one drug only for all included subjects, whereas the articles on mixed bisphosphonates used a variety of different bisphosphonates within the individual study. One article on etidronate (40), one on risedronate (42), and three reporting on mixed bisphosphonates (45–47) provided data to the calculation of an average decrease in s-calcium of (0.16 ± 0.049 mmol/l). Treatment duration varied from a single dose treatment to 5 years.…”

Section: Resultsmentioning

confidence: 99%

“…Three long-term treatment regimens (45, 47, 48), and one short term (46). The short-term study describes the use of bisphosphonates in pretreatment of patients undergoing parathyroidectomy and claims that bisphosphonate treatment can prevent development of hungry bones syndrome [although the number of patients treated is very limited ( n = 6)].…”

Section: Resultsmentioning

confidence: 99%

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Contemporary Medical Management of Primary Hyperparathyroidism: A Systematic Review

et al. 2017

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IntroductionPrimary hyperparathyroidism is increasingly an asymptomatic disease at diagnosis, but the recognized guidelines for management are based on evidence obtained from studies on patients with symptomatic disease, and surgery is not always indicated. Other patients are unable to undergo surgery, and thus a medical treatment is warranted. This systematic review provides an overview of the existing literature on contemporary pharmaceutical options available for the medical management of primary hyperparathyroidism.MethodsDatabases of medical literature were searched for articles including terms for primary hyperparathyroidism and each of the included drugs. Data on s-calcium, s-parathyroid hormone, bone turnover markers, bone mineral density (BMD) and hard endpoints were extracted and tabulated, and level of evidence was determined. Changes in s-calcium were estimated and a meta-regression analysis was performed.ResultsThe 1,999 articles were screened for eligibility and 54 were included in the review. Weighted mean changes calculated for each drug in s-total calcium (mean change from baseline ± SEM) were pamidronate (0.31 ± 0.034 mmol/l); alendronate (0.07 ± 0.05 mmol/l); clodronate (0.20 ± 0.040 mmol/l); mixed bisphosphonates (0.16 ± 0.049 mmol/l); and cinacalcet (0.37 ± 0.013 mmol/l). The meta-analysis revealed a significant decrease of effect on s-calcium with time for the bisphosphonates (Coef. −0.049 ± 0.023, p = 0.035), while cinacalcet proved to maintain its effect on s-calcium over time. Bisphosphonates improved BMD while cinacalcet had no effect.DiscussionThe included studies demonstrate advantages and drawbacks of the available pharmaceutical options that can prove helpful in the clinical setting. The great variation in how primary hyperparathyroidism is manifested requires that management should rely on an individual evaluation when counseling patients. Combining resorptive agents with calcimimetics could prove rewarding, but more studies are warranted.

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“…A study that did longitudinally evaluate these 3 modes of treatment in PHPT did not have renal function listed among the outcomes particularly explored. [ 18 ] All these studies have been performed exclusively on Caucasians.…”

Section: Introductionmentioning

confidence: 99%

Surgery or no surgery: What works best for the kidneys in primary hyperparathyroidism? A study in a multi-ethnic Asian population

Tay¹,

Khoo²,

Chandran³

2016

Indian J Endocr Metab

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Introduction:Whether parathyroidectomy is more beneficial to renal function when compared to medical therapy or observation in primary hyperparathyroidism (PHPT) is unclear. Neither has this premise been explored in non-Caucasian populations. The estimated glomerular filtration rate (eGFR) threshold below which parathyroid hormone (PTH) levels rise if at all in PHPT has also not been established. We determined if surgery was superior to medical therapy and observation in a multi-ethnic Asian patient population with PHPT and whether there was an eGFR threshold below which PTH levels further increased in them.Methods:Retrospective evaluation of patients with PHPT.Results:There were 68.6% Chinese, 17.4% Malays, 10.7% Indians, and 3.3% Eurasians. The median (interquartile range) follow-up was 18.0 months (4.5–46.8). At last follow-up, eGFR in the surgical (80 ± 30 ml/min) was higher than the medical (52 ± 32 ml/min) or observation groups (48 ± 33 ml/min); P < 0.01. This difference persisted after adjusting for age, gender, ethnicity, pre-intervention eGFR levels, nephrolithiasis, serum calcium, phosphate, urinary calcium, and duration of follow-up; P = 0.035. There was no definite eGFR level below which PTH values rose.Conclusion:Our study provides compelling evidence that in PHPT, surgery may be associated with a better renal outcome compared to medical management or observation. This has to be confirmed through prospective randomized controlled trials and the reasons for this finding have to be elucidated through functional and histological measures. The finding in our study of a lack of a specific eGFR threshold below which PTH levels further rose challenges the concept of a fixed renal threshold for secondary elevations of PTH in PHPT.

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Pierwotna nadczynność przytarczyc o niewielkim nasileniu — porównanie leczenia farmakologicznego i obserwacji klinicznej w ramach trwającego pięć lat badania klinicznego

Cited by 9 publications

References 22 publications

Quality of Life After Surgery or Surveillance for Asymptomatic Primary Hyperparathyroidism

Quality of Life After Surgery or Surveillance for Asymptomatic Primary Hyperparathyroidism

Contemporary Medical Management of Primary Hyperparathyroidism: A Systematic Review

Surgery or no surgery: What works best for the kidneys in primary hyperparathyroidism? A study in a multi-ethnic Asian population

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