Head-to-head comparison of the new calcimimetic agent evocalcet with cinacalcet in Japanese hemodialysis patients with secondary hyperparathyroidism.

Abstract

Secondary hyperparathyroidism (SHPT) leads to cardiovascular calcification, which affects survival and quality of life in patients with chronic kidney disease. Cinacalcet is used to control SHPT, but it may induce gastrointestinal symptoms, resulting in lower adherence and insufficient dosages. Therefore, a need exists to develop new calcimimetics that cause fewer gastrointestinal symptoms. Here we conducted a phase 3, randomized, double-blind, double-dummy trial for a head-to-head comparison of the efficacy and safety of evocalcet, a new oral calcimimetic, to the established cinacalcet. Japanese patients with SHPT on hemodialysis were randomized to receive evocalcet or cinacalcet (317 patients each) for 30 weeks. The primary efficacy endpoint was non-inferiority of evocalcet to cinacalcet in the proportion of patients achieving a mean intact parathyroid hormone level of 60 to 240 pg/mL from week 28 to 30 (non-inferiority margin, -15%, per protocol set analyses). In the evocalcet and cinacalcet groups, 72.7% and 76.7%, respectively, achieved the target intact parathyroid hormone level (between-group difference: -4.0% [95% confidence interval -11.4%, 3.5%], for non-inferiority). The incidence of gastrointestinal-related adverse events was 18.6% and 32.8%, respectively (between-group difference: -14.2% [-20.9%, -7.5%], significant for superiority). Thus, the non-inferiority of evocalcet to cinacalcet in suppressing intact parathyroid hormone with fewer gastrointestinal-related adverse events was demonstrated. Hence, evocalcet may be a favorable alternative to existing calcimimetics for management of SHPT.

• Authors: Masafumi Fukagawa, Ryutaro Shimazaki, Tadao Akizawa, Evocalcet study group
• Journal: Kidney international (Kidney Int) Vol. 94 Issue 4 Pg. 818-825 (10 2018) ISSN: 1523-1755 [Electronic] United States
• PMID: 30049473 (Publication Type: Clinical Trial, Phase III, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2018 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Calcimimetic Agents
• Naphthalenes
• Parathyroid Hormone
• Pyrrolidines
• evocalcet
• Cinacalcet

Topics

• Aged
• Calcimimetic Agents (adverse effects, therapeutic use)
• Cinacalcet (adverse effects, therapeutic use)
• Double-Blind Method
• Female
• Gastrointestinal Diseases (chemically induced)
• Humans
• Hyperparathyroidism, Secondary (blood, drug therapy)
• Japan
• Male
• Middle Aged
• Naphthalenes (adverse effects, therapeutic use)
• Parathyroid Hormone (blood)
• Pyrrolidines (adverse effects, therapeutic use)
• Renal Dialysis
• Renal Insufficiency, Chronic (therapy)