Etelcalcetide Beneficial in Severe SHPT Uncontrolled With Cinacalcet
In a study, patients with uncontrolled SHPT were switched from oral cinacalcet to intravenous etelcalcetide.
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SAN DIEGO— Etelcalcetide treatment can improve secondary hyperparathyroidism (SHPT) in patients on hemodialysis (HD) that is uncontrolled with cinacalcet, Andre L. Weigert, MD, and colleagues from DaVita Portugal reported in a poster presentation at the American Society of Nephrology's Kidney Week 2018 conference.
Among HD patients attending 3 DaVita Portugal clinics, 34 (mean age 60.7 years) had mean intact parathyroid hormone (iPTH) levels exceeding 800 pg/mL and total calcium values above 8.3 mg/dL for at least 3 months, despite cinacalcet treatment (median dose 180 mg/week). After a brief washout period, patients converted to intravenous etelcalcetide 5 mg given after dialysis sessions.
Over 6 months, the team observed significant declines in mean iPTH, serum calcium, and serum phosphorus. Mean iPTH decreased from 1005 to 702 pg/mL, serum calcium decreased from 8.8 to 8.1 mg/dL, and serum phosphorus decreased from 5.4 to 4.9 mg/dL.
In a subset of patients, serum fibroblast growth factor 23 (FGF23) decreased significantly from 39.3 to 29.1 pmol/L.
“Etelcalcetide improved control of severe SHPT in patients undergoing cinacalcet treatment, with reductions in serum calcium and phosphorus levels and also in FGF-23 levels, compared to baseline values,” Dr Weigert's team concluded.
The study also showed that that etelcalcetide increased the plasma sclerostin level significantly from 37.2 to 71.7 pmol/L, a previously unknown effect of the drug.
“It is possible that this effect of etelcalcetide on sclerostin levels may translate into a protective effect on vascular calcification, at the same time reducing osteoblast activity and bone remodeling in the setting of high-turnover bone disease.”
The study was funded by DaVita.
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Weigert AL, Amoedo MA, Mendes T, et al. Etelcalcetide in the treatment of secondary hyperparathyroidism in patients uncontrolled with cinacalcet – Results from a prospective study. Presented at the American Society of Nephrology's Kidney Week 2018 conference in San Diego, Oct. 23-28. Poster SA-PO657.