Efficacy of Paricalcitol vs Other VDRAs Unclear

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Meta-analysis shows comparable efficacy in lowering iPTH, but analyses of patient-centered outcomes such as mortality and cardiovascular death were not possible.
Meta-analysis shows comparable efficacy in lowering iPTH, but analyses of patient-centered outcomes such as mortality and cardiovascular death were not possible.

A new systematic review and meta-analysis found no significant difference in the efficacy and safety of paricalcitol versus other vitamin D receptor activators (VDRAs) in the treatment of secondary hyperparathyroidism (SHPT) in dialysis patients based on biochemical endpoints.

The researchers who conducted the study, however, pointed out that comparisons based on patient-centered outcomes were not possible because of the lack of randomized controlled trials providing data on patient-level outcomes, such as mortality, cardiovascular death, and quality of life.

“The evidence that is presently available is insufficient to draw a conclusion regarding whether paricalcitol therapy has a comparative efficacy and safety over other VDRAs for treating dialysis patients with SHPT,” Yifeng Xie, MD, of the Third Affiliated Hospital of Guangxi University of Chinese Medicine in China, and colleagues concluded in a paper published online ahead of print in BMC Nephrology.

The investigators pooled results from 8 randomized controlled trials published on or before June 2017 that directly compared VDRAs (e.g., calcitriol, alfacalcidol, maxacalcitol) in peritoneal or hemodialysis patients. Dr Xie's team reported finding no significant differences in the proportion of patients attaining the target range of intact parathyroid hormone (iPTH), defined as either a greater than 30% or 50% reduction in iPTH, with paricalcitol, based on 5 trials including a total of 696 patients. Compared with non-selective VDRAs (calcitriol and alfacalcidol) and a selective VDRA (maxacalcitol), paricalcitol had similar efficacy in suppressing iPTH. Hypercalcemia and hyperphosphatemia developed in similar percentages of patients. All patients were taking phosphate binders concurrently, some calcium-based.

Reference

Xie Y, Su P, Sun Y, Zhang H, Zhao R, Li L, and Meng L. Comparative efficacy and safety of paricalcitol versus vitamin D receptor activators for dialysis patients with secondary hyperparathyroidism: a meta-analysis of randomized controlled trials. BMC Nephrol 2017;18:272. doi:10.1186/s12882-017-0691-6 [Epub ahead of print]

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