CINACALCET FOR MANAGING SECONDARY HYPERPARATHYROIDISM IN DIALYSIS PATIENTS IN CLINICAL PRACTICE IN BELGIUM: A 16-MONTH OBSERVATIONAL STUDY (ECHO-B)

Abstract

In Belgium, the calcimimetic cinacalcet is initially reimbursed for ≤ 4 months in dialysis patients with secondary hyperparathyroidism (SHPT) and intact parathyroid hormone (iPTH) ≥ 800 pg/mL, or iPTH 300-800 pg/mL and Ca × P > 55 mg2/dL2 despite ≥ 6 months’ optimal treatment with vitamin D sterols and/or phosphate binders. The Belgian, multicentre, observational study ECHO-B evaluated cinacalcet in such patients. Patients who began cinacalcet treatment after March 1, 2007 were eligible. Data were collected retro/prospectively from 6 months before until 16 months after starting cinacalcet (whether or not cinacalcet was continued).

Median iPTH was markedly elevated (816 [IQR 551-991] pg/mL) at baseline (the time of starting cinacalcet), but decreased continuously over the course of the study, reaching a value of 414 pg/mL (IQR 240-641; median change -41%) at 4 months, 335 pg/mL (IQR 159-616; -60%) at 12 months and 250 pg/mL (IQR 172-436; -64%) at 16 months. Reductions in serum calcium (-7%) and phosphorus (-13%) were already (near) maximal at 4 months. The primary outcome (iPTH 150-300 pg/mL and/or a ≥ 30% reduction within 4 months of tarting cinacalcet; criterion for continued reimbursement in Belgium) was achieved in 65/81 patients (80%; 95% CI 72-89%).

Results show that in dialysis patients with SHPT in real-life clinical practice, mineral metabolism improves after starting cinacalcet: our study findings suggest that PTH levels may continue decreasing after 12 months’ treatment in this setting.

Keywords:

• chronic kidney disease
• secondary hyperparathyroidism
• cinacalcet