Journal Information
Vol. 38. Issue. 6.November - December 2018
Pages 573-680
Vol. 38. Issue. 6.November - December 2018
Pages 573-680
Letter to the Editor
DOI: 10.1016/j.nefroe.2018.02.016
Open Access
A light in the control of secondary hyperparathyroidism. Etelcalcetide IV in haemodialysis
Una luz en el control del hiperparatiroidismo secundario. Etelcalcetide intravenoso en hemodiálisis
Visits
768
Paola Villabón Ochoaa,
Corresponding author
paitobon@hotmail.com

Corresponding author.
, Marta Sánchez Herasa,b, Andrea Zapata Balcázara, Patricia Sánchez Escuderoa, Jose R. Rodríguez Palomaresa,b, Gabriel de Arriba de la Fuentea,b
a Servicio de Nefrología, Hospital Universitario de Guadalajara, Guadalajara, Spain
b Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá de Henares (UAH), Alcalá de Henares, Madrid, Spain
This item has received
768
Visits

Under a Creative Commons license
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Tables (1)
Table 1. Changes in patient's serum level over time.
Full Text
Dear Editor,

Secondary hyperparathyroidism (HPT) is a very common complication that worsens and exacerbates chronic kidney disease (CKD). It is associated with the genesis of vascular calcifications and with increased cardiovascular morbidity and mortality.1,2

According to data from the Spanish Society of Nephrology, more than 23,000 patients in Spain undergo haemodialysis (HD), and approximately 35% of these patients have HPT.3

The treatment of HPT is based on the control of dietary phosphorus intake, the administration of phosphate binders and vitamin D supplements, the activation of vitamin D receptors, and the administration of calcimimetic agents that activate the calcium-sensing receptor (CaSR) of the parathyroid glands.4,5 Most of these treatments are administered orally and are not entirely free from adverse effects; therapeutic outcomes depend to a large extent on patient adherence. Calcimimetic agents in particular are associated with gastrointestinal side effects.1,4

Recently, a new long-acting calcimimetic agent (etelcalcetide) was approved for intravenous use in HD patients with secondary hyperparathyroidism.5 Etelcalcetide binds directly to CaSR, inhibiting the production and secretion of parathyroid hormone (PTH) by the parathyroid glands. One of the main advantages of the drug is its intravenous route of administration, which is likely to promote patient adherence to treatment.5

Since there are very few reports on its use in Spain, we believe that our experience in a patient with severe HPT and poor adherence to oral calcimimetics will be of interest.

This was a 57-year-old patient with CKD secondary to autosomal dominant polycystic kidney disease, who had been receiving HD since June 2011. She had undergone surgery for breast cancer in 2013, and presented difficult-to-control HPT despite treatment with lanthanum carbonate (2g/8h), calcium acetate (500mg/day), sevelamer (1600mg/8h), cinacalcet (60mg/day) and IV paricalcitol (1μm after each HD session).

The patient had complained of gastrointestinal symptoms since the start of treatment with cinacalcet, which persisted despite antiemetics. The nausea and vomiting at times even prevented her from eating. Gastroscopy was performed, which was normal.

We requested authorisation to use etelcalcetide for compassionate use. Cinacalcet was discontinued, and after 10 days treatment was started at a dose of 2.5mg after each HD session. Calcifediol was discontinued, but paricalcitol was maintained.

The results are shown in Table 1.

Table 1.

Changes in patient's serum level over time.

Date of test  PTH (pg/ml)  Calcium (mg/dl)  Phosphorus (mg/dl) 
July 2017  1223  9.3  4.3 
Start of treatment with etelcalcetide (07/08/2017)
August 2017  912  9.8  5.3 
September 2017  764  8.7  3.0 
October 2017  686  7.8  5.6 
November 2017  701  8.4  4.9 
December 2017  486  8.4  4.8 

PTH: parathyroid hormone.

Etelcalcetide reduced intact parathyroid hormone (iPTH) levels by 56% after 2 months. Phosphorus and calcium levels were also maintained within reference ranges, with no symptoms of hypocalcaemia. The nausea and vomiting ceased, and the patient was able to increase food intake and progressively gain weight (Fig. 1).

Fig. 1.

Timeline of analytical results.

(0.15MB).

Etelcalcetide was shown to be more effective than placebo in patients on HD, and reduced iPTH levels by 30% or more in 76% of treated patients compared with 10% of patients treated with placebo.6 In a recent clinical trial, 683 patients on HD with secondary HPT and serum iPTH levels of over 500pg/ml received etelcalcetide or cinacalcet for 26 weeks. The results showed that etelcalcetide reduced iPTH levels by more than 30% in 68.2% of patients compared to 57.7% of those treated with cinacalcet, with a similar reduction in serum calcium.6 Furthermore, the incidence of gastrointestinal side effects was lower in patients treated with etelcalcetide.6

In summary, etelcalcetide is a promising drug in the treatment of HPT in HD patients. It has shown at least similar efficacy to cinacalcet, and its main advantages are improved adherence to treatment in polymedicated patients, and a lower rate of gastrointestinal side effects.5,7,8

References
[1]
M. Ketteler, G.A. Block, P. Evenepoel, M. Fukagawa, C.A. Herzog, L. McCann, et al.
Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) guideline update: what's changed and why it matters.
Kidney Int, 92 (2017), pp. 26-36
[2]
S. Moe, T. Drueke, J. Cunningham, W. Goodman, K. Martin, K. Olgaard, et al.
Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO).
Kidney Int, 69 (2006), pp. 1945-1953
[3]
J.V. Torregrosa, J. Bover, J. Cannata Andia, V. Lorenzo, A.L. de Francisco, I. Martínez, et al.
Spanish Society of Nephrology recommendations for controlling mineral and bone disorder in chronic kidney disease patients (SEN-MBD).
[4]
J.B. Wetmore, L.D. Quarles.
Treatment of secondary hyperparathyroidism in kidney disease: what we know and do not know about use of calcimimetics and vitamin D analogs.
Int J Nephrol Renovasc Dis, 1 (2008), pp. 5-17
[5]
L. Yu, J.E. Tomlinson, S.T. Alexander, K. Hensley, C.Y. Han, D. Dwyer, et al.
Etelcalcetide, a novel calcimimetic prevents vascular calcification in a rat model of renal insufficiency with secondary hyperparathyroidism.
Calcif Tissue Int, 101 (2017), pp. 641-653
[6]
G.A. Block, D.A. Bushinsky, S. Cheng, J. Cunningham, B. Dehmel, T.B. Drueke, et al.
Effect of etelcalcetide vs cinacalcet on serum parathyroid hormone in patients receiving hemodialysis with secondary hyperparathyroidism: a randomized clinical trial.
JAMA, 317 (2017), pp. 156-164
[7]
J. Bover, P. Urena, C. Ruiz-Garcia, I. daSilva, P. Lescano, J. del Carpio, et al.
Clinical and practical use of calcimimetics in dialysis patients with secondary hyperparathyroidism.
Clin J Am Soc Nephrol, 11 (2016), pp. 161-174
[8]
B. Stollenwerk, S. Iannazzo, K. Cooper, V. Belozeroff.
Exploring the potential value of improved care for secondary hyperparathyroidism with a novel calcimimetic therapy.

Please cite this article as: Villabón Ochoa P, Sánchez Heras M, Zapata Balcázar A, Sánchez Escudero P, Rodríguez Palomares JR, de Arriba de la Fuente G. Una luz en el control del hiperparatiroidismo secundario. Etelcalcetide intravenoso en hemodiálisis. Nefrologia. 2018;38:677–678.

Copyright © 2018. Sociedad Española de Nefrología
Idiomas
Nefrología (English Edition)

Subscribe to our newsletter

Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.