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首页> 外文期刊>Drug Design, Development and Therapy >Role of etelcalcetide in the management of secondary hyperparathyroidism in hemodialysis patients: a review on current data and place in therapy
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Role of etelcalcetide in the management of secondary hyperparathyroidism in hemodialysis patients: a review on current data and place in therapy

机译：依他卡西肽在血液透析患者继发性甲状旁腺功能亢进症管理中的作用：当前数据和治疗方法的回顾

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Secondary hyperparathyroidism (sHPT) is a frequently occurring severe complication of advanced kidney disease. Its clinical consequences include extraskeletal vascular and valvular calcifications, changes in bone metabolism resulting in renal osteodystrophy, and an increased risk of cardiovascular morbidity and mortality. Calcimimetics are a cornerstone of parathyroid hormone (PTH)-lowering therapy, as confirmed by the recently updated 2017 Kidney Disease: Improving Global Outcomes chronic kidney disease – mineral and bone disorder clinical practice guidelines. Contrary to calcitriol or other vitamin D-receptor activators, calcimimetics reduce PTH without increasing serum-calcium, phosphorus, or FGF23 levels. Etelcalcetide is a new second-generation calcimimetic that has been approved for the treatment of sHPT in adult hemodialysis patients. Whereas the first-generation calcimimetic cinacalcet is taken orally once daily, etelcalcetide is given intravenously thrice weekly at the end of the hemodialysis session. Apart from improving drug adherence, etelcalcetide has proven to be more effective in lowering PTH when compared to cinacalcet, with an acceptable and comparable safety profile. The hope for better gastrointestinal tolerance with intravenous administration did not come true, as etelcalcetide did not significantly mitigate the adverse gastrointestinal effects associated with cinacalcet. Enhanced adherence and strong reductions in PTH, phosphorus, and FGF23 could set the stage for a future large randomized controlled trial to demonstrate that improved biochemical control of mineral metabolism with etelcalcetide in hemodialysis patients translates into cardiovascular and survival benefits and better health-related quality of life.
机译：继发性甲状旁腺功能亢进症（sHPT）是晚期肾脏疾病中经常发生的严重并发症。其临床后果包括骨骼外血管和瓣膜钙化，骨代谢变化导致肾性骨营养不良以及心血管疾病发病率和死亡率增加。拟态药物是降低甲状旁腺激素（PTH）疗法的基石，最近更新的《 2017年肾脏病：改善整体疗效慢性肾脏病–矿物质和骨病临床实践指南》证实了这一点。与骨化三醇或其他维生素D受体激活剂相反，拟钙剂可降低PTH而不增加血清钙，磷或FGF23的水平。 Etelcalcetide是一种新型的第二代拟钙剂，已被批准用于治疗成人血液透析患者的sHPT。每天口服一次第一代拟钙剂西那卡塞，而血液透析疗程结束时每周三次三次静脉给予依卡西肽。除改善药物依从性外，与西那卡塞相比，依他卡塞肽已被证明在降低PTH方面更有效，并且具有可接受且可比较的安全性。静脉内给药对更好的胃肠道耐受性的希望没有实现，因为依卡西肽不能显着减轻与西那卡塞有关的胃肠道不良反应。依从性的增强和PTH，磷和FGF23的强烈降低可以为未来的大型随机对照试验奠定基础，该试验证明用依替卡西肽改善血液透析患者对矿物质代谢的生化控制可转化为心血管和生存益处，以及与健康相关的更好质量生活。

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