Paricalcitol May Be More Efficacious Than Cinacalcet in HD
Therapy with paricalcitol alone achieved the greatest decline in intact parathyroid hormone among hemodialysis with secondary hyperparathyroidism.
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NEW ORLEANS—Intravenous treatment with paricalcitol alone shows the most efficacy in lowering intact parathyroid hormone (iPTH) levels in hemodialysis patients with secondary hyperparathyroidism (SHPT), investigators reported at Kidney Week 2017.
“Treatment with intravenous paricalcitol should be considered for all hemodialyzed patients with inadequate serum PTH level control,” lead investigator Jacek Zawierucha, MD, of Fresenius Medicare Care Polska SA in Poland, told Renal & Urology News. “SHPT treatment with cinacalcet should be considered for peritoneal dialysis patients and when severe hypercalcemia occurs.”
Of 131 patients with elevated iPTH (mean 1072 pg/mL), 60 received paricalcitol alone, 50 cinacalcet alone, and 21 a combination of cinacalcet and paricalcitol (after unsatisfactory results with cinacalcet monotherapy).
At 1 year, all groups experienced significant decline in iPTH, with the lowest level achieved in the paricalcitol-only group: 369 pg/mL vs 536 pg/mL with cinacalcet alone and 743 pg/mL for the combined treatment.
According to the investigators, iPTH dropped to its lowest levels (390 pg/mL) after 3 months of therapy, then stabilized. The team suggested reevaluating the treatment strategy when a patient has inadequate response after 3 months.
All 3 strategies showed similar safety. There were no episodes of severe hypercalcemia or hypocalcemia.
The study was funded by Fresenius Medical Care, which manufactures paricalcitol. The team is planning a future clinical trial with a greater number of patients.
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1. Zawierucha JP, Malyszko J, Malyszko JS, et al. Secondary hyperparathyroidism in hemodialysed patients – Comparison of the most common strategies of treatment in a one-year observational study. Presented in poster format at Kidney Week 2017 in New Orleans (Oct. 31-Nov.5). Abstract FR-PO289.