Etelcalcetide Beneficial in Severe SHPT Uncontrolled With Cinacalcet

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In a study, patients with uncontrolled SHPT were switched from oral cinacalcet to intravenous etelcalcetide.
In a study, patients with uncontrolled SHPT were switched from oral cinacalcet to intravenous etelcalcetide.
The following article is part of conference coverage from Kidney Week 2018 in San Diego hosted by the American Society of Nephrology. Renal & Urology News staff will be reporting live on medical studies conducted by nephrologists and other specialists who are tops in their field in acute kidney injury, chronic kidney disease, dialysis, transplantation, and more. Check back for the latest news from Kidney Week 2018.

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.


Visit Renal & Urology News' conference section for continuous coverage from Kidney Week 2018.

Reference

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.

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