CINACALCET_- cinacalcet_tablet, film coated

The calcium-sensing receptor on the surface of the chief cell of the parathyroid gland is the principal regulator of PTH synthesis and secretion. Cinacalcet, the active ingredient in cinacalcet tablets, is a calcimimetic agent that directly lowers PTH levels by increasing the sensitivity of the calcium-sensing receptor to activation by extracellular calcium. The reduction in PTH is associated with a concomitant decrease in serum calcium levels. Reduction in iPTH levels correlated with the plasma cinacalcet concentrations in patients with CKD. The nadir in iPTH level occurs approximately 2 to 6 hours post dose, corresponding with the maximum plasma concentration (C max Reductions in PTH are associated with a decrease in bone turnover and bone fibrosis in patients with CKD on dialysis and uncontrolled secondary HPT. Absorption and Distribution After oral administration of cinacalcet, C max max (0-infinite) max (0-infinite) After absorption, cinacalcet concentrations decline in a biphasic fashion with an initial half-life of approximately 6 hours and terminal half-life of 30 to 40 hours. Steady-state drug levels are achieved within 7 days, and the mean accumulation ratio is approximately 2 with once daily oral administration. The median accumulation ratio is approximately 2 to 5 with twice daily oral administration. The AUC and C max Metabolism and Excretion Cinacalcet is metabolized by multiple enzymes, primarily CYP3A4, CYP2D6, and CYP1A2. After administration of a 75 mg radiolabeled dose to healthy volunteers, cinacalcet was metabolized via: 1) oxidative N-dealkylation to hydrocinnamic acid and hydroxy-hydrocinnamic acid, which are further metabolized via beta-oxidation and glycine conjugation; the oxidative N-dealkylation process also generates metabolites that contain the naphthalene ring; and 2) oxidation of the naphthalene ring on the parent drug forming dihydrodiols, which are further conjugated with glucuronic acid. The plasma concentrations of the major circulating metabolites, including the cinnamic acid derivatives and glucuronidated dihydrodiols, markedly exceed the parent drug concentrations. The hydrocinnamic acid metabolite and glucuronide conjugates have minimal or no calcimimetic activity. Renal excretion of metabolites was the primary route of elimination of radioactivity. Approximately 80% of the dose was recovered in the urine and 15% in the feces. Specific Populations Age: Geriatric Population The pharmacokinetic profile of cinacalcet in geriatric patients (age >= 65 years, n = 12) is similar to that for patients who are < 65 years of age (n = 268) [see Use in Specific Populations (8. 5)] Hepatic Impairment The disposition of a 50 mg cinacalcet single dose was compared between patients with hepatic impairment and patients with normal hepatic function. Cinacalcet exposure (AUC (0-infinite) (0-infinite) [see Use in Specific Populations (8. Renal Impairment The pharmacokinetic profile of a 75 mg cinacalcet single dose in patients with mild, moderate, and severe renal impairment, and those on hemodialysis or peritoneal dialysis is comparable with that in healthy volunteers [see Use in Specific Populations (8. 6)] Drug Interactions In vitro studies indicate that cinacalcet is a strong inhibitor of CYP2D6, but not an inhibitor of CYP1A2, CYP2C9, CYP2C19, and CYP3A4. In vitro induction studies indicate that cinacalcet is not an inducer of CYP450 enzymes. Tables 5 and 6 list the findings from in vivo drug-drug interaction studies. Effect of co-administered drugs on cinacalcet * Single dose Co-administered drug and dosing regimen Cinacalcet Dose* Mean change in AUC (0-inf) Mean change in C max 200 mg ketoconazole twice daily for 7 days 90 mg on day 5 up arrow127% up arrow116% 1500 mg calcium carbonate, single dose 100 mg down arrow6% down arrow5% 80 mg pantoprazole daily for 3 days 90 mg on day 3 up arrow1% down arrow3% 2400 mg sevelamer HCl three times a day for 2 days 90 mg on day 1 with first dose of sevelamer down arrow4% down arrow7% Table 6. Effect of cinacalcet co-administration on other drugs * No significant change in prothrombin time daggerSingle dose on day 5 double daggerNortriptyline is an active metabolite of amitriptyline. Cinacalcet dosing regimen Co-administered drug Name and Dose Mean change in AUC (0-inf) Mean change in C max 30 mg twice daily for 8 days 25 mg warfarin* tablet dagger up arrow1 % for R-warfarin down arrow10 % for R-warfarin 90 mg daily for 7 days to CYP2D6 extensive metabolizers 50 mg desipramine dagger up arrow264% up arrow75% 90 mg daily for 5 days 2 mg midazolam dagger up arrow5% down arrow5% 25 or 100 mg single dose to CYP2D6 extensive metabolizers 50 mg amitriptyline single dose up arrow21 to 22% for amitriptyline double dagger up arrow13 to 21% for amitriptyline double dagger.

Cinacalcet is a positive modulator of the calcium sensing receptor indicated for: Secondary Hyperparathyroidism (HPT) in adult patients with chronic kidney disease (CKD) on dialysis. 1) Limitations of Use: Hypercalcemia in adult patients with Parathyroid Carcinoma (PC). 2) Severe hypercalcemia in adult patients with primary HPT who are unable to parathyroidectomy. 3) Cinacalcet tablets are indicated for the treatment of secondary hyperparathyroidism (HPT) in adult patients with chronic kidney disease (CKD) on dialysis [see Clinical Studies (14. Limitations of Use: Cinacalcet tablets are not indicated for use in patients with CKD who are not on dialysis because of an increased risk of hypocalcemia [see Warnings and Precautions (5. 1)] Cinacalcet tablets are indicated for the treatment of hypercalcemia in adult patients with Parathyroid Carcinoma [see Clinical Studies (14. Cinacalcet tablets are indicated for the treatment of severe hypercalcemia in adult patients with primary HPT who are unable to undergo parathyroidectomy [see Clinical Studies (14.

Cinacalcet tablets should be taken with food or shortly after a meal (2. 1) Tablets should always be taken whole and not divided (2. 1) Secondary HPT in patients with CKD on dialysis (2. 2): Starting dose is 30 mg once daily. Titrate dose no more frequently than every 2 to 4 weeks through sequential doses of 30 mg, 60 mg, 90 mg, 120 mg, and 180 mg once daily as necessary to achieve targeted intact parathyroid hormone (iPTH) levels. iPTH levels should be measured no earlier than 12 hours after most recent dose. Hypercalcemia in patients with PC or severe hypercalcemia in patients with primary HPT (2. 3): Starting dose is 30 mg twice daily. Titrate dose every 2 to 4 weeks through sequential doses of 30 mg twice daily, 60 mg twice daily, 90 mg twice daily, and 90 mg three or four times daily as necessary to normalize serum calcium levels. Once the maintenance dose has been established, monitor serum calcium approximately monthly for patients with secondary HPT and every 2 months for patients with PC or primary HPT (2. 4) Cinacalcet tablets should be taken with food or shortly after a meal. Cinacalcet tablets are administered orally and should always be taken whole and not chewed, crushed, or divided. The recommended starting oral dose of cinacalcet tablets is 30 mg once daily. Serum calcium and serum phosphorus should be measured within 1 week and intact parathyroid hormone iPTH) should be measured 1 to 4 weeks after initiation or dose adjustment of cinacalcet tablets [see Dosage and Administration (2. Cinacalcet tablets can be used alone or in combination with vitamin D sterols and/ or phosphate binders. During dose titration, serum calcium levels should be monitored frequently and if levels decrease below the normal range, appropriate steps should be taken to increase serum calcium levels, such as by providing supplemental calcium, initiating or increasing the dose of calcium-based phosphate binder, initiating or increasing the dose of vitamin D sterols, or temporarily withholding treatment with cinacalcet tablets [see Dosage and Administration (2. 4) and Warnings and Precautions (5. The recommended starting oral dose of cinacalcet tablets is 30 mg twice daily. The dose of cinacalcet tablets should be titrated every 2 to 4 weeks through sequential doses of 30 mg twice daily, 60 mg twice daily, and 90 mg twice daily, and 90 mg 3 or 4 times daily as necessary to normalize serum calcium levels. Serum calcium should be measured within 1 week after initiation or dose adjustment of cinacalcet tablets [see Dosage and Administration (2. Discontinue etelcalcetide for at least 4 weeks prior to starting cinacalcet. Ensure corrected serum calcium is at or above the lower limit of normal prior to cinacalcet. initiation [see Warnings and Precautions (5. 1)] Once the maintenance dose has been established, serum calcium should be measured approximately monthly for patients with secondary hyperparathyroidism with CKD on dialysis, and every 2 months for patients with parathyroid carcinoma or primary hyperparathyroidism [see Dosage and Administration (2. For secondary hyperparathyroidism patients with CKD on dialysis, if serum calcium falls below 8. 4 mg/dL but remains above 7. 5 mg/dL, or if symptoms of hypocalcemia occur, calcium- containing phosphate binders and/or vitamin D sterols can be used to raise serum calcium. If serum calcium falls below 7. 5 mg/dL, or if symptoms of hypocalcemia persist and the dose of vitamin D cannot be increased, withhold administration of cinacalcet tablets until serum calcium levels reach 8. 0 mg/dL and/or symptoms of hypocalcemia have resolved. Treatment should be reinitiated using the next lowest dose of cinacalcet tablets [see Dosage and Administration (2.

The following adverse reactions are discussed in greater detail in other sections of labeling: Hypocalcemia [see Warnings and Precautions (5. 1)] Upper Gastrointestinal Bleeding [see Warnings and Precautions (5. 2)] Hypotension, Worsening Heart Failure and/or Arrhythmias [see Warnings and Precautions (5. 3)] Adynamic Bone Disease [see Warnings and Precautions (5. 4)] The most common adverse reactions (i. , >= 25%) associated with cinacalcet were nausea and vomiting. (6) To report SUSPECTED ADVERSE REACTIONS, contact Strides Pharma Global Pte. at 1-877-244-9825 or FDA at 1-800-FDA-1088 or www. gov/medwatch. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. Secondary Hyperparathyroidism in Patients with Chronic Kidney Disease on Dialysis In three double-blind, placebo-controlled clinical trials, 1126 patients with CKD on dialysis received study drug (656 cinacalcet, 470 placebo) for up to 6 months. The most frequently reported adverse reactions are listed in Table 1. Seizures were observed in 1. 4% (13/910) of cinacalcet-treated patients and 0. 7% (5/641) of placebo-treated patients across all completed placebo-controlled trials. Adverse Reactions with Frequency >= 5% in Patients on Dialysis in Short-Term Studies for up to 6 Months *Included are events that were reported at a greater incidence in the cinacalcet group than in the placebo group. Event*: Placebo Cinacalcet (n = 470) (n = 656) (%) (%) Nausea 19 31 Vomiting 15 27 Diarrhea 20 21 Myalgia 14 15 Dizziness 8 10 Hypertension 5 7 Asthenia 4 7 Anorexia 4 6 Pain Chest, Non-Cardiac 4 6 Dialysis Access Site Infection 4 5 In a randomized, double-blind placebo-controlled study of 3883 patients with secondary HPT and CKD receiving dialysis in which patients were treated for up to 64 months (mean duration of treatment was 21 months in the cinacalcet group), the most frequently reported adverse reactions (incidence of >= 5% in the cinacalcet group and a difference >= 1% compared to placebo) are listed in Table 2. Frequency of Adverse Reactions in Dialysis Patients Treated for up to 64 Months in a Long-Term Study 1 1 Crude incidence rate = 100 * Total number of subjects with event/ n n=Number of subjects receiving at least one dose of study drug. Placebo Cinacalcet 3699 subject-years 4044 subject-years Percent of subjects reporting Adverse Reactions (%) 90. 2 Nausea 15. 1 Vomiting 13. 6 Diarrhea 18. 5 Dyspnea 11. 7 Hypotension 10. 6 Headache 9. 5 Hypocalcemia 1. 2 Muscle spasms 9. 1 Abdominal pain 9. 9 Abdominal pain upper 6. 2 Hyperkalemia 6. 1 Upper respiratory tract infection 6. 6 Dyspepsia 4. 4 Dizziness 4. 3 Decreased appetite 3. 9 Asthenia 3. 4 Constipation 3. 0 Additional adverse reaction rates from the long-term, randomized, double-blind placebo controlled study for cinacalcet versus placebo are as follows: seizure (2. 6%), rash (2. 9%), hypersensitivity reactions (9. Patients with Parathyroid Carcinoma and Primary Hyperparathyroidism The safety profile of cinacalcet in these patient populations is generally consistent with that seen in patients with CKD on dialysis. Forty six patients were treated with cinacalcet in a single-arm study; 29 with Parathyroid Carcinoma and 17 with intractable pHPT. Nine (20%) of the patients withdrew from the study due to adverse events. The most frequent adverse reactions and the most frequent cause of withdrawal in these patient populations were nausea and vomiting. Severe or prolonged cases of nausea and vomiting can lead to dehydration and worsening hypercalcemia so careful monitoring of electrolytes is recommended in patients with these symptoms. Eight patients died during treatment with cinacalcet in this study, 7 with Parathyroid Carcinoma (24%) and 1 (6%) with intractable pHPT. Causes of death were cardiovascular (5 patients), multi-organ failure (1 patient), gastrointestinal hemorrhage (1 patient) and metastatic carcinoma (1 patient). Adverse events of hypocalcemia were reported in three patients (7%). Seizures were observed in 0. 7% (1/140) of cinacalcet-treated patients and 0. 0% (0/46) of placebo-treated patients in all clinical studies. Adverse Reactions with Frequency >=10% in a Single Arm, Open-Label Study in Patients with Primary Hyperparathyroidism or Parathyroid Carcinoma n = Number of subjects receiving at least one dose of study drug. pHPT = primary hyperparathyroidism Cinacalcet Parathyroid Carcinoma Intractable pHPT Total Number of Subjects Reporting 28 (97) 17 (100) 45 (98) Nausea 19 (66) 10 (59) 29 (63) Vomiting 15 (52) 6 (35) 21 (46) Paresthesia 4 (14) 5 (29) 9 (20) Fatigue 6 (21) 2 (12) 8 (17) Fracture 6 (21) 2 (12) 8 (17) Hypercalcemia 6 (21) 2 (12) 8 (17) Anorexia 6 (21) 1 (6) 7 (15) Asthenia 5 (17) 2 (12) 7 (15) Dehydration 7 (24) 0 (0) 7 (15) Anemia 5 (17) 1 (6) 6 (13) Arthralgia 5 (17) 1 (6) 6 (13) Constipation 3 (10) 3 (18) 6 (13) Depression 3 (10) 3 (18) 6 (13) Headache 6 (21) 0 (0) 6 (13) Infection Upper Respiratory 3 (10) 2 (12) 5 (11) Pain Limb 3 (10) 2 (12) 5 (11) Hypocalcemia In 26-week studies of patients with secondary HPT and CKD on dialysis 66% of patients receiving cinacalcet compared with 25% of patients receiving placebo developed at least one serum calcium value less than 8. 4 mg/dL, whereas, 29 % of patients receiving cinacalcet compared with 11% of patients receiving placebo developed at least one serum calcium value less than 7. Less than 1% of patients in each group permanently discontinued study drug due to hypocalcemia. In a randomized, double-blind, placebo-controlled study in patients with secondary HPT and CKD receiving dialysis in which patients were treated for up to 64 months (mean duration of treatment was 21 months in the cinacalcet group), 75% of patients receiving cinacalcet compared with 29% of patients receiving placebo developed at least one serum calcium value less than 8. 4 mg/dL and 33% of cinacalcet patients compared with 12% of patients receiving placebo had at least one serum calcium value less than 7. Most of the cases of severe hypocalcemia less than 7. 5mg/dL (21/33=64%) occurred during the first 6 months. In this trial, 1. 1% of patients receiving cinacalcet and 0. 1% of patients receiving placebo permanently discontinued study drug due to hypocalcemia. The following adverse reactions have been identified during post approval use of cinacalcet tablets. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Rash and hypersensitivity reactions (including angioedema and urticaria), and myalgia Isolated, idiosyncratic cases of hypotension, worsening heart failure, and/or arrhythmia have been reported in patients with impaired cardiac function Gastrointestinal bleeding Chondrocalcinosis pyrophosphate (acute pseudogout).

Cinacalcet tablets treatment initiation is contraindicated if serum calcium is less than the lower limit of the normal range [see Warnings and Precautions (5. Cinacalcet tablets treatment initiation is contraindicated if serum calcium is less than the lower limit of the normal range.

Pediatric Use: A fatal outcome was reported in a pediatric clinical trial patient with severe hypocalcemia. Cinacalcet is not indicated for use in pediatric patients. 4) Risk Summary Limited case reports of cinacalcet tablets use in pregnant women are insufficient to inform a drug associated risk of adverse developmental outcomes. In animal reproduction studies, when female rats were exposed to cinacalcet during the period of organogenesis through to weaning at 2-3 times the systemic drug levels (based on AUC) at the maximum recommended human dose (MRHD) of 180 mg/day, peripartum and early postnatal pup loss and reduced pup body weight gain were observed in the presence of maternal hypocalcemia [see Data]. The estimated background risk of major birth defects and miscarriage for the indicated populations is unknown. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. Data Animal Data In pregnant female rats given oral gavage doses of 2, 25, 50 mg/kg/day cinacalcet during gestation, no teratogenicity was observed at doses up to 50 mg/kg/day (exposure 4 times those resulting with a human oral dose of 180 mg/day based on AUC comparison). Decreased fetal body weights were observed at all doses (less than 1 to 4 times a human oral dose of 180 mg/ day based on AUC comparison) in conjunction with maternal toxicity (decreased food consumption and body weight gain). In pregnant female rabbits given oral gavage doses of 2, 12, 25 mg/kg/day cinacalcet during gestation, no adverse fetal effects were observed (exposures less than with a human oral dose of 180 mg/day based on AUC comparisons). Reductions in maternal food consumption and body weight gain were seen at doses of 12 and 25 mg/kg/day. Cinacalcet has been shown to cross the placental barrier in rabbits. In pregnant rats given oral gavage doses of 5, 15, 25 mg/kg/day cinacalcet during gestation through lactation, no adverse fetal or pup (post-weaning) effects were observed at 5 mg/kg/day (exposures less than with a human therapeutic dose of 180 mg/day based on AUC comparisons). Higher doses of 15 and 25 mg/kg/day cinacalcet (exposures 2 to 3 times a human oral dose of 180 mg/day based on AUC comparisons) were accompanied by maternal signs of hypocalcemia (periparturient mortality and early postnatal pup loss), and reductions in postnatal maternal and pup body weight gain. Risk Summary There are no data regarding the presence of cinacalcet in human milk or effects on the breastfed infant or on milk production. Studies in rats showed that cinacalcet was excreted in the milk. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for cinacalcet tablets and any potential adverse effects on the breastfed infant from cinacalcet tablets or from the underlying maternal condition. The safety and efficacy of cinacalcet tablets have not been established in pediatric patients. Dosing with cinacalcet tablets in a Pediatric Study was stopped because of a fatality in a cinacalcet-treated Individual. The individual was noted to be severely hypocalcemic at the time of death. The cause of death was multifactorial and a contribution of cinacalcet tablets to the death could not be excluded (see Warnings and Precautions (5. 1) Additional information describing clinical studies in which efficacy was not demonstrated in pediatric patients is approved for Amgen Inc. 's Sensipar registered (cinacalcet) product. However, due to Amgen Inc. 's marketing exclusivity rights, this drug product is not labeled with that pediatric information. Of the total number of subjects (n=1136) in clinical studies of cinacalcet, 26 percent were 65 and over, and 9 percent were 75 and over. No overall differences in the safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger subjects, but greater sensitivity of some older individuals cannot be ruled out [see Clinical Studies (14) and Clinical Pharmacology (12. 3)] No dosage adjustment is necessary for renal impairment [see Clinical Pharmacology (12. Patients with moderate and severe hepatic impairment should have serum calcium, serum phosphorus, and iPTH levels monitored closely throughout treatment with cinacalcet because cinacalcet exposure (AUC 0-infinite [see Clinical Pharmacology (12.

Co-administration with a strong CYP3A4 inhibitor may increase serum levels of cinacalcet. Dose adjustment and monitoring of iPTH serum phosphorous and serum calcium may be required. 1) Cinacalcet is a strong inhibitor of CYP2D6. Dose adjustments may be required for concomitant medications that are predominantly metabolized by CYP2D6. 2) Cinacalcet is partially metabolized by CYP3A4. Dose adjustment of cinacalcet tablets may be required if a patient initiates or discontinues therapy with a strong CYP3A4 inhibitor (e. , ketoconazole, itraconazole). The iPTH and serum calcium concentrations should be closely monitored in these patients [see Clinical Pharmacology (12. 3)] Cinacalcet is a strong inhibitor of CYP2D6. Dose adjustments may be required for concomitant medications that are predominantly metabolized by CYP2D6 (e. , desipramine, metoprolol, and carvedilol) and particularly those with a narrow therapeutic index (e. , flecainide and most tricyclic antidepressants) [see Clinical Pharmacology (12.

OVERDOSAGE
Overdosage of cinacalcet may lead to hypocalcemia. In the event of overdosage, patients should be monitored for signs and symptoms of hypocalcemia and appropriate measures taken to correct serum calcium levels [see Warnings and Precautions (5.1)]. Since cinacalcet is highly protein bound, hemodialysis is not an effective treatment for overdosage of cinacalcet.
NONCLINICAL TOXICOLOGY
Carcinogenicity Standard lifetime dietary carcinogenicity bioassays were conducted in mice and rats. Mice were given cinacalcet at dietary doses of 15, 50, and 125 mg/kg/day in males and 30, 70, and 200 mg/kg/day in females (exposures up to 2 times those resulting with a human oral dose of 180 mg/day based on AUC comparison). Rats were given dietary doses of 5, 15, and 35 mg/kg/day in males and 5, 20, and 35 mg/kg/day in females (exposures up to 2 times those resulting with a human oral dose of 180 mg/day based on AUC comparison). No increased incidence of tumors was observed following treatment with cinacalcet. Mutagenicity Cinacalcet was not genotoxic in the Ames bacterial mutagenicity assay, nor in the Chinese Hamster Ovary (CHO) cell HGPRT forward mutation assay and CHO cell chromosomal aberration assay, with and without metabolic activation, nor in the in vivo mouse micronucleus assay. Impairment of Fertility Female rats were given oral gavage doses of 5, 25, and 75 mg/kg/day cinacalcet beginning 2 weeks before mating and continuing through gestation day 7. Male rats were given oral doses 4 weeks prior to mating, during mating (3 weeks) and 2 weeks postmating. No effects were observed in male or female fertility at 5 and 25 mg/kg/day (exposures up to 3 times those resulting with a human oral dose of 180 mg/day based on AUC comparison). At 75 mg/kg/day, there were slight adverse effects (slight decreases in body weight and food consumption) in males and females.
CLINICAL STUDIES
Three 6-month, multicenter, randomized, double-blind, placebo-controlled clinical studies of similar design were conducted in patients with CKD on dialysis. A total of 665 patients were randomized to cinacalcet and 471 patients to placebo. The mean age of the patients was 54 years, 62% were male, and 52% were Caucasian. The average baseline iPTH level by the Nichols IRMA was 712 pg/mL, with 26% of the patients having a baseline iPTH level > 800 pg/mL. The mean baseline Ca x P product was 61 mg 2 2 Similar results were observed when either the iPTH or biointact PTH (biPTH) assay was used to measure PTH levels in CKD patients on dialysis; treatment with cinacalcet did not alter the relationship between iPTH and biPTH. Effects of Cinacalcet on iPTH, Ca x P, Serum Calcium, and Serum Phosphorus in 6-month Phase 3 Studies (Patients on Dialysis) Values shown are medians unless indicated otherwise *iPTH value based on averaging over the evaluation phase (defined as weeks 13 to 26 in studies 1 and 2 and weeks 17 to 26 in study 3). dagger p < 0. 001 compared with placebo; p-values presented for primary endpoint only Study 1 Study 2 Study 3 Placebo Cinacalcet Placebo Cinacalcet Placebo Cinacalcet (n = 205) (n = 205) (n = 165) (n = 166) (n = 101) (n = 294) iPTH Baseline (pg/mL): 535 537 556 547 670 703 Mean (SD) 651 (398) 636 (341) 630 (317) 652 (372) 832 (486) 848 (685) Evaluation Phase (pg/mL) 563 275 592 238 737 339 Median Percent Change +3. 2 Patients Achieving Primary 4% 41%dagger 7% 46%dagger 6% 35%dagger pg/mL) (%)* Patients Achieving >= 30% 11% 61% 12% 68% 10% 59% Patients Achieving iPTH <= 1% 32% 5% 35% 5% 28% mg2/dL2 (%) Ca x P Baseline (mg2/dL2) 62 61 61 61 61 59 Evaluation Phase (mg2/dL2) 59 52 59 47 57 48 Median Percent Change -2. 7 Calcium Baseline (mg/dL) 9. 8 Evaluation Phase (mg/dL) 9. 1 Median Percent Change +0. 0 Phosphorus Baseline (mg/dL) 6. 0 Evaluation Phase (mg/dL) 6. 3 Median Percent Change -1. Mean (SE) iPTH Values (Pooled Phase 3 Studies) Data are presented for patients who completed the studies; Placebo (n = 342), cinacalcet (n = 439). Mean (SE) Ca x P Values (Pooled Phase 3 Studies) Data are presented for patients who completed the studies; Placebo (n = 342), cinacalcet (n = 439). Reductions in iPTH and Ca x P were maintained for up to 12 months of treatment. Cinacalcet decreased iPTH and Ca x P levels regardless of disease severity (i. , baseline iPTH value), duration of dialysis, and whether or not vitamin D sterols were administered. Approximately 60% of patients with mild (iPTH >= 300 to <= 500 pg/mL), 41% with moderate (iPTH > 500 to 800 pg/mL), and 11% with severe (iPTH > 800 pg/mL) secondary HPT achieved a mean iPTH value of <= 250 pg/mL. Plasma iPTH levels were measured using the Nichols IRMA. Twenty-nine patients with Parathyroid Carcinoma were enrolled in a single-arm, open-label study. The study consisted of two phases, a dose-titration phase and a maintenance phase. Patients initially received 30 mg cinacalcet twice daily and then were titrated every 2 weeks to a maximum dose of 90 mg four times daily. Dosage escalation during the variable-length (2 to 16 weeks) titration phase continued until the serum calcium concentration was <= 10 mg/dL (2. 5 mmol/L), the patient reached the highest possible dosage, or adverse events precluded further dosage increases. Twenty- nine patients entered the study. The median exposure to cinacalcet was 229 days (range: 1 to 1051). At baseline the mean (SE) serum calcium was 14. At the end of the titration phase, the mean (SE) serum calcium was 12. 5) mg/dL, which is a mean reduction of 1. 6) mg/dL from baseline. Figure 3 illustrates mean serum calcium (mg/dL) over time for all patients still on study at each time point from the beginning of titration to study visit week 80. Daily dose during the study ranged from 30 mg twice daily to 90 mg four times daily. Serum Calcium Values in Patients with Parathyroid Carcinoma Receiving Cinacalcet at Baseline, Titration, and Maintenance Phase n = Number of patients with non-missing values at the time point. End of Titration (EOT) phase could occur at any visit from week 2 to 16. Patients at EOT are those who completed titration. Seventeen patients with severe hypercalcemia due to primary HPT, who had failed or had contraindications to parathyroidectomy, participated in an open-label, single-arm study. In this trial, severe hypercalcemia was defined as a screening serum calcium level of > 12. Patients initially received 30 mg cinacalcet twice daily and then were titrated every 2 weeks to a maximum dose of 90 mg 4 times daily. Seventeen patients entered the study. The median exposure to cinacalcet was 270 days (range: 32 to 1,105). At baseline the mean (SE) serum calcium was 12. At the end of the titration phase the mean (SE) serum calcium was 10. 3) mg/dL, which is a mean reduction of 2. 3) mg/dL from baseline. Figure 4 illustrates mean serum calcium (mg/dL) over time for all patients still on study at each time point from the beginning of titration to study visit week 80. Daily dose during the study ranged from 30 mg twice a day to 90 mg four times a day. Mean Serum Calcium (SE) at Baseline, End of Titration, and Scheduled Maintenance Visits (Patients with Severe intractable primary HPT) n = Number of patients with non-missing values at the timepoint. Figure 1 Figure 2 figure-3 Figure-4.

Strides Pharma Inc.

CINACALCET_- cinacalcet_tablet, film coated Product manual source documgent