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Treatment of secondary hyperparathyroidism: How do cinacalcet and etelcalcetide differ?
Semin Dial. 2018 09; 31(5):440-444.SD

Abstract

Secondary hyperparathyroidism (SHPT), commonly encountered in patients receiving maintenance dialysis, is associated with numerous adverse outcomes, including mortality. Calcimimetics, agents that act on the calcium sensing receptor (CaSR), were designed to overcome limitations in the use of vitamin D sterols to treat SHPT, and have demonstrated efficacy in reducing levels of PTH in randomized trials. Currently available calcimimetics include oral cinacalcet and the recently approved intravenously administered agent, etelcalcetide. While cinacalcet is an allosteric modulator of the CaSR, etelcalcetide acts as a direct CaSR agonist. Etelcalcetide's properties allow it to be administered intravenously thrice weekly at the end of a hemodialysis treatment session. Etelcalcetide has recently been shown to be more potent than cinacalcet in reducing PTH levels. However, etelcalcetide appears, like cinacalcet, to cause gastrointestinal intolerance. Additionally, etelcalcetide, which appears to reduce calcium substantially more than cinacalcet does, can prolong the QTc electrocardiographic interval. While etelcalcetide is very effective at reducing PTH levels, the current climate of dialysis cost containment in the United States may limit its widespread use. This review compares and contrasts the pharmacologic characteristics of cinacalcet and etelcalcetide, discusses the results of clinical trials involving these drugs, and posits implications for their use for clinical practice.

Authors+Show Affiliations

Division of Nephrology, Hennepin Healthcare Systems, Minneapolis, MN, USA.Division of Nephrology, Hennepin Healthcare Systems, Minneapolis, MN, USA. Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA.

Pub Type(s)

Editorial
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

30009474

Citation

Eidman, Keith E., and James B. Wetmore. "Treatment of Secondary Hyperparathyroidism: How Do Cinacalcet and Etelcalcetide Differ?" Seminars in Dialysis, vol. 31, no. 5, 2018, pp. 440-444.
Eidman KE, Wetmore JB. Treatment of secondary hyperparathyroidism: How do cinacalcet and etelcalcetide differ? Semin Dial. 2018;31(5):440-444.
Eidman, K. E., & Wetmore, J. B. (2018). Treatment of secondary hyperparathyroidism: How do cinacalcet and etelcalcetide differ? Seminars in Dialysis, 31(5), 440-444. https://doi.org/10.1111/sdi.12734
Eidman KE, Wetmore JB. Treatment of Secondary Hyperparathyroidism: How Do Cinacalcet and Etelcalcetide Differ. Semin Dial. 2018;31(5):440-444. PubMed PMID: 30009474.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of secondary hyperparathyroidism: How do cinacalcet and etelcalcetide differ? AU - Eidman,Keith E, AU - Wetmore,James B, Y1 - 2018/07/15/ PY - 2018/7/17/pubmed PY - 2019/5/9/medline PY - 2018/7/17/entrez SP - 440 EP - 444 JF - Seminars in dialysis JO - Semin Dial VL - 31 IS - 5 N2 - Secondary hyperparathyroidism (SHPT), commonly encountered in patients receiving maintenance dialysis, is associated with numerous adverse outcomes, including mortality. Calcimimetics, agents that act on the calcium sensing receptor (CaSR), were designed to overcome limitations in the use of vitamin D sterols to treat SHPT, and have demonstrated efficacy in reducing levels of PTH in randomized trials. Currently available calcimimetics include oral cinacalcet and the recently approved intravenously administered agent, etelcalcetide. While cinacalcet is an allosteric modulator of the CaSR, etelcalcetide acts as a direct CaSR agonist. Etelcalcetide's properties allow it to be administered intravenously thrice weekly at the end of a hemodialysis treatment session. Etelcalcetide has recently been shown to be more potent than cinacalcet in reducing PTH levels. However, etelcalcetide appears, like cinacalcet, to cause gastrointestinal intolerance. Additionally, etelcalcetide, which appears to reduce calcium substantially more than cinacalcet does, can prolong the QTc electrocardiographic interval. While etelcalcetide is very effective at reducing PTH levels, the current climate of dialysis cost containment in the United States may limit its widespread use. This review compares and contrasts the pharmacologic characteristics of cinacalcet and etelcalcetide, discusses the results of clinical trials involving these drugs, and posits implications for their use for clinical practice. SN - 1525-139X UR - https://wwww.unboundmedicine.com/medline/citation/30009474/Treatment_of_secondary_hyperparathyroidism:_How_do_cinacalcet_and_etelcalcetide_differ DB - PRIME DP - Unbound Medicine ER -