Real-world data favour etelcalcetide for treating SHPT in multiethnic Asians

Etelcalcetide proves beneficial in the real-world treatment of secondary hyperparathyroidism (SHPT) in multiethnic Asian haemodialysis patients, with the added advantage of reducing pill burden, as shown in a study from Singapore.

“Our real-world experience by performing a clinical audit showed that etelcalcetide was safe and effective,” the investigators said.

After 4 months of therapy, the mean intact-parathyroid hormone (PTH) levels dropped by 16.8 percent, from 147 pmol/L at baseline to 118 pmol/L (p<0.001). The proportion of patients who reached the target intact-PTH level of <60 pmol/L increased progressively from 1.4 percent at baseline to 22.3 percent at month 4 (p<0.001) and 25.9 percent at month 8 (p=0.028). [Cureus 2023;15:e48186]

The mean serum calcium remained relatively stable from a safety standpoint during the study period. Hypocalcaemia (<8.4 mg/dL) occurred in 12.8 percent of patients at month 4 and in 21.4 percent of patients at month 8, but none of them reported any symptoms or signs at such serum calcium levels and experienced cardiac or other complications.

Moreover, the calcium-phosphate product significantly decreased at months 4 (13.2 percent; p<0.001) and 8 (12.7 percent; p<0.05).

A total of 148 patients (median age 61.5 years, 57.4 percent men, 58.1 percent Chinese) received etelcalcetide during the study period. Of these patients, 10 died, 20 discontinued their medication, and 118 remained on treatment.  

Most of the patients (65.5 percent) had a starting dose of 2.5 mg three times a week, with a mean treatment duration of 5.28 months.

Gentle on the gut

As second-generation calcimimetic that is given intravenously, etelcalcetide reduces the PTH level by binding to the CaSR and enhancing the receptor activation by extracellular calcium. A key objective in the drug’s development is to address gastrointestinal side effects seen with the first-generation oral calcimimetic agent and, in turn, improve patient adherence to treatment. [JAMA 2017;317:139-141; N Engl J Med 2012;367:2482-2494]

Indeed, the study showed no gastrointestinal side effects among patients treated with etelcalcetide, as pointed out by the investigators.

One less pill to take

“[Furthermore], etelcalcetide was found to be helpful in general to the patient’s overall personal perception of their compliance to their treatment regimens,” the investigators said, highlighting polypharmacy and pill-burden as an issue that hinders compliance to medication and leads to poor clinical outcomes and quality of life. [Saudi Pharm J 2023;31:678-686]

As such, the investigators suggested that an overall strategy to use drug alternatives available in intravenous forms may help reduce polypharmacy and pill burden for chronic haemodialysis patients.

“[S]uch a broader strategy may significantly improve clinical outcomes for patients suffering from poor clinical outcomes due to noncompliance. Further studies would be needed to study this interesting aspect of the overall clinical management of chronic haemodialysis patients in the community,” they added. [PLoS One 2015;10:e0144119]