Summary

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• Parsabiv (etelcalcetide) is indicated for secondary hyperparathyroidism (HPT) in adult patients with chronic kidney disease (CKD) on hemodialysis.
• This summary is based on the review of two systematic review(s)/meta-analysis(es). ^[1-2]
• Etelcalcetide significantly increased the likelihood of achieving target PTH levels compared to evocalcet (OR, 4.93; 95% CI, 1.33-18.2) and cinacalcet (OR, 2.78; 95% CI, 1.19-6.67) in dialysis patients.
• In patients receiving hemodialysis, etelcalcetide resulted in more participants achieving a ≥ 30% reduction in PTH (RR 8.64; 95% CI, 6.66 to 11.19; p < 0.00001) and a PTH level of ≤ 300 pg/mL (RR 11.80; 95% CI, 8.15 to 17.08; p < 0.00001) compared to placebo.
• Etelcalcetide was also effective in reducing serum phosphate (MD -7.28; 95% CI, -8.82 to -5.74; p < 0.00001), calcium phosphorus product (MD -14.48; 95% CI, -15.07 to -13.88), and bone-specific alkaline phosphatase (MD -24.80; 95% CI, -28.91 to -20.68) levels in this population.
• Etelcalcetide increased the incidence of hypocalcemia (RR 18.76; 95% CI, 4.55 to 77.26; p < 0.0001), nausea (RR 1.79; 95% CI, 1.19 to 2.70; p = 0.006), and vomiting (RR 1.82; 95% CI, 1.17 to 2.85; p = 0.008) compared to placebo.
• Differences in the risk of serious adverse events, all-cause mortality, cardiovascular mortality, heart failure, or fractures across calcimimetic agents could not be discerned with sufficient certainty.
• The reviewed evidence pertains primarily to adults with chronic kidney disease, particularly those on dialysis, with a focus on patients with secondary hyperparathyroidism receiving hemodialysis. The findings emphasize the effectiveness of etelcalcetide in controlling serum PTH and mineral metabolism disorders in this subgroup, though it is associated with an increased risk of hypocalcemia and other side effects. The evidence is limited to short-term assessments, and differences in side-effect profiles exist across calcimimetic agents.