3 The technology

3.1 Cinacalcet (Mimpara: Amgen Ltd) is a calcimimetic agent which increases the sensitivity of calcium-sensing receptors to extracellular calcium ions, thereby inhibiting the release of PTH. It is licensed for the treatment of secondary hyperparathyroidism in patients with ESRD on maintenance dialysis therapy. It may be used as part of a therapeutic regimen including phosphate binders and/or vitamin D sterols, as appropriate. It is initiated at a dose of 30 mg once daily, titrated every 2–4 weeks to a maximum of 180 mg once daily to achieve a target level of intact PTH of between 15.9 and 31.8 pmol/litre (150–300 pg/ml).

3.2 Because cinacalcet lowers calcium levels, it is contraindicated if serum calcium is below the lower limit of the normal range. The most commonly reported adverse effects in clinical trials were nausea and vomiting. These were mild to moderate in nature and transient in most cases. For full details of side effects and contraindications, see the summary of product characteristics (SPC).

3.3 The drug costs of treatment with cinacalcet are between £1646 and £9110 per year depending on the dose administered (excluding VAT; 'British national formulary' edition 51). Costs may vary in different settings because of negotiated procurement discounts.