Xu Wei, Gong Lifeng, Lu Jingkui, Tang Weigang
Department of Nephrology, Wujin Hospital Affiliated to Jiangsu University, Changzhou, Jiangsu 213000, P.R. China.
Department of Nephrology, Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu 213000, P.R. China.
Exp Ther Med. 2020 Oct;20(4):3237-3243. doi: 10.3892/etm.2020.9044. Epub 2020 Jul 24.
Paricalcitol and cinacalcet have been recommended to reduce parathyroid hormone (PTH) levels for patients with secondary hyperparathyroidism (SHPT) and chronic kidney disease (CKD), and they are able to reduce the risk of hypercalcemia and hyperphosphatemia. However, to date, it has remained uncertain which is the better drug. The aim of the present meta-analysis was to evaluate the effects on PTH, calcium and phosphorus metabolism between the two drugs. The PubMed, the Cochrane Library and Embase databases were searched from inception to June 1, 2019 and eligible studies comparing paricalcitol and cinacalcet for SHPT were included. Data were analysed using Review Manager version 5.3. A total of 7 trials from six articles, comprising 456 patients in the paricalcitol group and 412 patients in the cinacalcet group, were included in the meta-analysis. There were no differences in PTH levels [mean difference (MD): 71.82, 95% CI: -185.20-328.85, P=0.58] and phosphorus levels (standard MD: 0.59, 95% CI: -0.82-2.00, P=0.41). The calcium levels in the paricalcitol group were significantly higher than those in the cinacalcet group (MD: 1.10, 95% CI: 0.92-1.28, P<0.05). In conclusion, paricalcitol and cinacalcet exhibited no difference in their efficacy to control of PTH levels, as they were similarly effective in decreasing the PTH levels. They also had comparable efficacy in the management of phosphorus levels. However, cinacalcet produced a significantly greater reduction in serum calcium levels. More large multicentre randomized controlled trials are necessary to confirm the conclusions of the present analysis.
帕立骨化醇和西那卡塞已被推荐用于降低继发性甲状旁腺功能亢进（SHPT）和慢性肾脏病（CKD）患者的甲状旁腺激素（PTH）水平，并且它们能够降低高钙血症和高磷血症的风险。然而，迄今为止，哪种药物更好仍不确定。本荟萃分析的目的是评估这两种药物对PTH、钙和磷代谢的影响。检索了PubMed、Cochrane图书馆和Embase数据库，检索时间从创建至2019年6月1日，纳入了比较帕立骨化醇和西那卡塞治疗SHPT的符合条件的研究。使用Review Manager 5.3版进行数据分析。荟萃分析共纳入了6篇文章中的7项试验，帕立骨化醇组有456例患者，西那卡塞组有412例患者。PTH水平[平均差（MD）：71.82，95%置信区间（CI）：-185.20至328.85，P = 0.58]和磷水平（标准化MD：0.59，95% CI：-0.82至2.00，P = 0.41）无差异。帕立骨化醇组的钙水平显著高于西那卡塞组（MD：1.10，95% CI：0.92至1.28，P < 0.05）。总之，帕立骨化醇和西那卡塞在控制PTH水平的疗效上无差异，因为它们在降低PTH水平方面同样有效。它们在管理磷水平方面也有相当的疗效。然而，西那卡塞使血清钙水平降低得更显著。需要更多大型多中心随机对照试验来证实本分析的结论。
