Comparative Effectiveness of Calcimimetic Agents for Secondary Hyperparathyroidism in Adults: A Systematic Review and Network Meta-analysis.
Am J Kidney Dis
; 76(3): 321-330, 2020 09.
Article
en En
| MEDLINE
| ID: mdl-32475604
ABSTRACT
RATIONALE & OBJECTIVE:
Comparative benefits and harms of calcimimetic agents used for the treatment of secondary hyperparathyroidism have not been well characterized. We sought to compare the effectiveness of 3 calcimimetic agents using published data. STUDYDESIGN:
Systematic review of randomized controlled trials and network meta-analysis. SETTING & STUDY POPULATION Adults with chronic kidney disease enrolled in a clinical trial of a calcimetic agent. SEARCH STRATEGY & SOURCES MEDLINE, EMBASE, CENTRAL (from February 7, 2013, to November 21, 2019), and a published meta-analysis. DATA EXTRACTION Two reviewers independently extracted the study data, assessed risk of bias, and rated evidence certainty using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. ANALYTICALAPPROACH:
Frequentist network meta-analysis was conducted. The primary review outcomes were achievement of a target reduction in serum parathyroid hormone (PTH) levels and hypocalcemia. Additional outcomes were nausea, vomiting, serious adverse events, all-cause mortality, cardiovascular mortality, heart failure, and fracture.RESULTS:
36 trials (11,247 participants) were included. All except 4 trials involved dialysis patients. Median follow-up was 26 weeks (range, 1 week to 21.2 months). Compared with placebo, calcimimetic agents had higher odds of achieving target PTH levels with high or moderate certainty. Etelcalcetide had the highest odds of achieving a PTH target compared with evocalcet (OR, 4.93; 95% CI, 1.33-18.2) and cinacalcet (OR, 2.78; 95% CI, 1.19-6.67). Etelcalcetide appeared to cause more hypocalcemia than cinacalcet and evocalcet. Cinacalcet and to a lesser extent etelcalcetide appeared to cause more nausea than placebo. Differences in risk for mortality, cardiovascular end points, or fractures across calcimimetic agents could not be discerned with sufficient certainty.LIMITATIONS:
Lack of longer-term data; heterogeneous end point definitions.CONCLUSIONS:
Evidence of the benefits of calcimimetic therapy is limited to short-term assessment of a putative surrogate outcome (serum PTH). Although etelcalcetide was associated with the largest reduction in PTH levels, side-effect profiles differed across the 3 calcimimetic agents, making it not possible to identify 1 preferred agent.Palabras clave
Calcimimetic; PTH target; cardiovascular disease (CVD); cinacalcet; dialysis; end-stage renal disease (ESRD); etelcalcetide; evidence-based medicine (EBM); evocalcet; fracture; gastrointestinal side effects; hypocalcemia; mortality; nausea; network meta-analysis; parathyroid hormone (PTH); randomized controlled trials (RCTs); renal failure; secondary hyperparathyroidism; systematic review; vomiting
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Péptidos
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Pirrolidinas
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Calcimiméticos
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Cinacalcet
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Hiperparatiroidismo Secundario
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Naftalenos
Tipo de estudio:
Clinical_trials
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Etiology_studies
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Guideline
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Prognostic_studies
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Systematic_reviews
Límite:
Adult
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Female
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Humans
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Male
Idioma:
En
Revista:
Am J Kidney Dis
Año:
2020
Tipo del documento:
Article
País de afiliación:
Nueva Zelanda