Among calcimimetic therapies, intravenous etelcalcetide reduces parathyroid hormone (PTH) levels more than oral cinacalcet in patients receiving hemodialysis, according to findings from a new real-world study.
Using the 2019 US Dialysis Outcomes and Practice Patterns Study, investigators identified 45 etelcalcetide-first and 67 cinacalcet-first hemodialysis facilities, defined as prescription to more than 75% of patients. Etelcalcetide-first facilities were more likely to be small or independent dialysis organizations (86% vs 22%). They had higher total calcimimetic use (43% vs 29%) and lower active vitamin D use (66% vs 82%).
In a cross-sectional analysis, mean PTH levels declined 115 pg/mL more at etelcalcetide-first facilities, and 11.4% fewer patients at these facilities had high PTH levels exceeding 600 pg/mL, Angelo Karaboyas, PhD, of Arbor Research Collaborative for Health, Ann Arbor, Michigan and colleagues reported in Kidney Medicine.
Among facilities that switched to etelcalcetide, mean PTH level decreased from 671 to 484 pg/mL and the prevalence of high PTH decreased from 39% to 21%. Among facilities that continued with cinacalcet, mean PTH level increased from 632 to 698 pg/mL and the prevalence of high PTH increased from 37% to 43%. Compared with continuing cinacalcet, switching to etelcalcetide was associated with a 169 pg/mL decline in mean PTH and a 14.4% decline in the prevalence of high PTH.
According to the investigators, etelcalcetide may have greater effectiveness than cinacalcet in the real-world setting in part due to better adherence to intravenous vs oral administration. They noted that etelcalcetide use in the United States remains limited by cost and payment policies.
“Further research is needed to investigate how the greater real-world effectiveness of intravenous etelcalcetide (vs oral cinacalcet) may affect clinical outcomes,” according to Dr Karaboyas’ team.
Disclosure: This research was supported by Amgen. Please see the original reference for a full list of disclosures.
Karaboyas A, Muenz D, Hwang Y, et al. Etelcalcetide versus cinacalcet in hemodialysis patients in the United States: A facility calcimimetic approach to assess real-world effectiveness. Kidney Med. 2022 Apr 29;4(6):100475. doi:10.1016/j.xkme.2022.100475