Synthetic Human Parathyroid Hormone 1-34 vs Calcitriol and Calcium in the Treatment of Hypoparathyroidism
Results of a Short-term Randomized Crossover Trial
- Karen K. Winer, MD;
- Jack A. Yanovski, MD, PhD;
- Gordon B. Cutler, Jr, MD
Abstract
Objective. —To test the hypothesis that treatment with human parathyroid hormone 1-34 (PTH 1-34) can maintain normal serum calcium without hypercalciuria in patients with hypoparathyroidism.
Design. —Randomized crossover trial lasting 20 weeks. Each 10-week arm consisted of a 2-week inpatient dose-adjustment phase followed by an 8-week outpatient phase.
Setting. —Tertiary care center.
Patients. —A total of 10 patients with hypoparathyroidism were enrolled consecutively over a 15-month period. Half of the patients were prior National Institutes of Health patients, and the other 5 patients were referred from outside physicians.
Interventions. —A dose of PTH 1-34 was administered each morning by subcutaneous injection. Calcitriol was given orally twice daily with supplemental calcium carbonate.
Main Outcome Measures. —Serum and urine calcium and phosphorus levels.
Results. —Once-daily treatment with PTH 1-34 maintained serum calcium in the normal range with decreased urine calcium excretion (P<.05 at 2 weeks and P<.01 at 10 weeks) compared with calcitriol treatment. Biochemical markers of bone turnover increased significantly (P<.01 at 10 weeks) during PTH 1-34 treatment.
Conclusions. —Treatment of hypoparathyroidism with PTH 1-34 reduces urine calcium excretion compared with treatment with calcitriol and calcium.
Footnotes
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Reprints: Karen K. Winer, MD, NICHD/DEB/SDE, Bldg 10, Room 10N262, 10 Center Dr, MSC 1862, National Institutes of Health, Bethesda, MD 20892-1862.
