Recombinant Human Parathyroid Hormone Effect on Health-Related Quality of Life in Adults With Chronic Hypoparathyroidism

Vokes, Tamara; Mannstadt, Michael; Levine, Michael A.; Clarke, B.L.; Lakatos, Péter L.; Chen, Kristina; Piccolo, Rebecca; Krasner, Alan; Shoback, Dolores; Bilezikian, John P.

doi:10.1210/jc.2017-01471

Cited by 66 publications

(67 citation statements)

References 19 publications

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“…Well-being was not being assessed in this study, but previous data showed failure to restore well-being in patients with HP with standard therapy of calcium and vitamin D (18,19). Therapy with rhPTH 1-84 may help to improve the quality of life in these patients (20). Hospitalization due to hypocalcaemia was rather rare in this study, having occurred in 5% of the cohort, with 75% of the hospitalizations occurring at the time of HP diagnosis and not during follow-up.…”

Section: Discussionmentioning

confidence: 85%

Long-term complications in patients with chronic hypoparathyroidism: a cross-sectional study

David

Moyson

Vanderschueren

et al. 2019

European Journal of Endocrinology

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Objective: Chronic hypoparathyroidism and its treatment may lead to symptoms and complications affecting quality of life. We determined complications in chronic hypoparathyroid patients. Design: Retrospective cross-sectional study of patients with chronic hypoparathyroidism treated with active vitamin D supplements in a tertiary care centre during the year 2015. Primary outcome parameters were history of kidney stones and seizures and presence of renal and cerebral calcifications on imaging. Secondary outcome parameters were current symptoms of paraesthesia/cramps, hospitalization due to hyper/hypocalcaemia and hypercalciuria. Subjects: One hundred and seventy patients were included -143 (84%) with post-surgical hypoparathyroidism (PSHP), 16 (9%) with non-surgical hypoparathyroidism (NSHP) and 11 (7%) with pseudo-hypoparathyroidism (PHP). Results: History of kidney stones and seizures was present in 15 and 9% of patients, respectively. Renal and cerebral imaging was performed in 51 and 26% of the patients, with 22 and 25% of these patients having renal and cerebral calcifications respectively. Both history of seizures and cerebral calcifications were significantly more in NSHP and PHP than in PSHP patients. No association was observed between seizures and cerebral calcifications. Cramps/paraesthesia were present in 16%, and hospitalization related to hypocalcaemia was reported in 5% of the patients. Calciuria was screened in 47% at the time of consultation, and in 76% of the patients during the past 5 years. In 36% of these patients, calciuria was increased. Conclusions: Patients with chronic hypoparathyroidism frequently develop ectopic calcifications. Non-surgical patients suffer more from seizures and cerebral calcifications than patients that developed hypoparathyroidism post surgery. There is a need for increased screening of long-term complications, according to the guidelines.

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Section: Discussionmentioning

confidence: 85%

Long-term complications in patients with chronic hypoparathyroidism: a cross-sectional study

David

Moyson

Vanderschueren

et al. 2019

European Journal of Endocrinology

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“…In addition, hypoparathyroid patients often describe neurocognitive complaints, including anxiety, depression, fatigue, and various cognitive deficits 13 , 18 , 34 , 35 . They have lower QoL scores, using validated tools, mostly the Short Form Health Survey 36 (SF-36), a self-administered 36-item questionnaire, compared with reference norms 18 , 19 , 34 , 36 , 37 . Both mental and physical domains are affected, although the mechanisms for the deficits are uncertain.…”

Section: Quality Of Life Complicationsmentioning

confidence: 99%

“…Anecdotally, patients report marked improvements, but a significant favorable effect of PTH-replacement therapy was not shown in double-blind randomized trials compared with controls receiving conventional therapy 20 , 36 . In the REPLACE study, SF-36 scores did not differ between the two treatment arms, rhPTH(1-84) versus placebo, at 24 weeks 36 . One can speculate that this negative finding was due to the lack of sustained PTH elevations with the frequency of PTH administration used.…”

Section: Quality Of Life Complicationsmentioning

confidence: 99%

Recent advances in understanding and managing hypoparathyroidism

Rubin

2020

F1000Res

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Hypoparathyroidism is a rare endocrine disorder which leads to hypocalcemia, hypercalciuria, and hyperphosphatemia. Complications include nephrocalcinosis with renal dysfunction, reduced quality of life, and abnormal skeletal properties. Conventional therapy with calcium and vitamin D analogs addresses hypocalcemia but has important limitations. Parathyroid hormone (PTH) therapy is a fundamental advance, although the effects of PTH on long-term complications require additional testing. Continuous PTH therapy is likely to be particularly advantageous for addressing renal, quality of life, and skeletal complications. Overall, much progress has been made, yet more information is needed to improve our understanding and management of hypoparathyroidism.

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“…From these 31 studies, four studies were finally included in this meta-analysis based on the selection criteria as mentioned above. Rest of the studies were excluded because of the following reasons: study done in children;[ 10 ] prospective design or unrelated population[ 11 12 13 25 26 27 28 29 30 31 32 33 34 35 36 ]; duplication of data[ 37 38 ]; comparison of different PTH doses[ 39 40 41 ]; evaluation of cost-effectiveness of PTH therapy[ 42 ]; and use of either pump therapy or continuous subcutaneous PTH infusion. [ 5 43 44 45 46 ]…”

Section: R Esultsmentioning

confidence: 99%

Parathyroid hormone replacement versus oral calcium and active vitamin D supplementation in hypoparathyroidism: A meta-analysis

Palui

Das

Roy

et al. 2020

Indian J Endocr Metab

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Objectives: Chronic hypoparathyroidism is treated conventionally with active vitamin D and high doses of calcium. Recombinant human parathyroid hormone (PTH) replacement is an attractive option for treating patients with hypoparathyroidism since it can replace the physiological action of native PTH. The aim of our study was to perform a comprehensive evaluation of the effects of PTH replacement on calcium homeostasis, bone metabolism, and daily requirement of calcium and active vitamin D. Materials and Methods: Randomized controlled trials done in chronic hypoparathyroid patients were included in this meta-analysis. The PTH group included subjects receiving a subcutaneous injection of either PTH (1-84) or PTH (1-34) with oral calcium and/or active vitamin D. The control group included those receiving oral calcium and active vitamin D with/without subcutaneous placebo injection. The primary outcome of this meta-analysis was to compare serum calcium, 24-h urinary calcium, and severe adverse effects among PTH and control groups. Results: In this meta-analysis, we did not find any difference in serum calcium level between PTH and control groups [mean difference (MD) - 0.01; 95% confidence interval (CI) - 0.09, 0.06; P = 0.71]. Although there was a trend towards low 24-h urinary calcium in the PTH group, the difference was not statistically significant (MD - 1.43; 95% CI - 2.89, 0.03; P = 0.06). The incidence of serious adverse events was also similar in both groups (RR 1.35; 95% CI 0.58, 3.16; P = 0.49). Conclusion: Both PTH and active vitamin D therapies are associated with comparable serum and urine calcium levels with a similar incidence of serious adverse events in patients with chronic hypoparathyroidism.

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Recombinant Human Parathyroid Hormone Effect on Health-Related Quality of Life in Adults With Chronic Hypoparathyroidism

Abstract: Treatment with rhPTH(1-84) may improve HRQoL in adults with hypoparathyroidism.

Cited by 66 publications

References 19 publications

Long-term complications in patients with chronic hypoparathyroidism: a cross-sectional study

Long-term complications in patients with chronic hypoparathyroidism: a cross-sectional study

Recent advances in understanding and managing hypoparathyroidism

Parathyroid hormone replacement versus oral calcium and active vitamin D supplementation in hypoparathyroidism: A meta-analysis

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