Arenas Maria Dolores, Rodelo-Haad Cristian, de Mier M Victoria Pendón-Ruiz, Rodriguez Mariano
Nephrology Department, Vithas Perpetuo Socorro International, Alicante, Spain.
Maimonides Biomedical Research Institute of Cordoba (IMIBIC)/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain.
Clin Kidney J. 2020 Feb 12;14(3):840-846. doi: 10.1093/ckj/sfaa005. eCollection 2021 Mar.
In dialysis patients, non-adherence to oral cinacalcet adds complexity to the control of secondary hyperparathyroidism. The present study aims to evaluate the use of intravenous calcimimetic, etelcalcetide, in the control of secondary hyperparathyroidism in patients adherent and non-adherent to oral calcimimetics.
The Simplified Medication Adherence Questionnaire was used to identify non-adherence. Almost half of the patients were non-adherent to the treatment with cinacalcet. Twenty-five patients (15 non-adherent) were switched from cinacalcet to etelcalcetide and were followed-up monthly for 8 months.
Cinacalcet was discontinued for 1 week before the initiation of etelcalcetide. After this period, the serum PTH levels increased by2-fold in adherent patients, whereas it did not change in non-adherent patients suggesting that they were not taking the medication. Etelcalcetide progressively reduced serum parathyroid hormone (PTH) (mean ± standard deviation) from 818 ± 395 to 367 ± 289 pg/mL (P<0.001) in non-adherents, and from 496 ± 172 to 228 ± 111 pg/mL (P<0.01) in adherent patients with a mean dose of 7.0 ± 2.3 and 5.1 ± 1.2 mg in non-adherent and in adherent patients, respectively. Etelcalcetide increased the percentage of patients with PTH on target from 28% to 58%. Patients with serum calcium <8.4 mg/dL increased from 8% to 40%, although they remained asymptomatic. The percent of patients with serum phosphate on target increased from 40% to 65%.
The lack of adherence to cinacalcet is a possible cause of the apparent lack of response to oral calcimimetic. The use of etelcalcetide ensures compliance and control of secondary hyperparathyroidism in both non-adherent and adherent patients.
在透析患者中，不坚持口服西那卡塞会增加继发性甲状旁腺功能亢进控制的复杂性。本研究旨在评估静脉注射拟钙剂依特卡肽在坚持和不坚持口服拟钙剂的患者中对继发性甲状旁腺功能亢进的控制作用。
使用简化药物依从性问卷来识别不依从情况。几乎一半的患者不坚持服用西那卡塞治疗。25名患者（15名不依从者）从西那卡塞转换为依特卡肽，并每月随访8个月。
在开始使用依特卡肽前1周停用西那卡塞。在此期间后，坚持服药的患者血清甲状旁腺激素（PTH）水平增加了2倍，而不坚持服药的患者血清PTH水平未变化，这表明他们未服用药物。依特卡肽使不坚持服药患者的血清甲状旁腺激素（PTH）（平均值±标准差）从818±395逐渐降至367±289 pg/mL（P<0.001），使坚持服药患者的血清PTH从496±172降至228±111 pg/mL（P<0.01），不坚持服药和坚持服药患者的平均剂量分别为7.0±2.3和5.1±1.2 mg。依特卡肽使PTH达标的患者百分比从28%增至58%。血清钙<8.4 mg/dL的患者从8%增至40%，尽管他们仍无症状。血清磷酸盐达标的患者百分比从40%增至65%。
不坚持服用西那卡塞可能是对口服拟钙剂明显缺乏反应的一个原因。使用依特卡肽可确保不坚持服药和坚持服药的患者对继发性甲状旁腺功能亢进的依从性和控制。
