Clinical nephrologyClinical nephrologyКлиническая нефрология2075-35942414-9322Bionika Media27394610.18565/nephrology.2022.1.73-87ArticlesСтатьиReview ArticleCalcimimetics in the treatment of secondary hyperparathyroisis in dialysis patients: comparison of the efficacy and safety of cinacalcet and etelcalcetideКальцимиметики в лечении вторичного гиперпаратиреоза у диализных пациентов: сравнение эффективности и безопасности цинакальцета и этелкальцетидаVolginaGalina VladimirovnaВолгинаГалина Владимировна

Prof

д.м.н., профессор

volginagv@mail.ruMoscow State University of Medicine and Dentistry named after A.i. Evdokimov of the Ministry of Healthcare of the Russian FederationФГБОУ во «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» М3 РФ15032022141VOL 14, NO1 (2022)ТОМ 14, №1 (2022)738722022023Copyright ©; 2022, Bionika MediaCopyright ©; 2022, ООО «Бионика Медиа»2022Bionika MediaООО «Бионика Медиа»https://journals.eco-vector.com/2075-3594/article/view/273946

Secondary hyperparathyroidism (SHPT), commonly encountered in patients receiving maintenance dialysis, is associated with numerous adverse outcomes, including vascular and valvular calcifications, changes in bone metabolism and an increased risk of cardiovascular morbidity and mortality. Calcimimetics, agents that act on the calcium sensing receptor (CaSR), were designed to overcome limitations in the use of vitamin d sterols to treat shpt, and have demonstrated efficacy in reducing levels of PTH in randomized trials. Currently available calcimimetics include oral cinacalcet (CC) and the recently approved intravenously administered agent, etelcalcetide (EC). while CC is an allosteric modulator of the casr, EC acts as a direct CaSR agonist. Etelcalcetide’s properties allow it to be administered intravenously thrice weekly at the end of a hemodialysis treatment session, which undoubtedly increases adherence to therapy and reduces the burden of using tablet preparations. In randomized clinical trials, EC has been shown to be more effective than CC in reducing levels of PTH, phosphate, calcium, fibroblast growth factor 23 (FGF23). This review compares and contrasts the pharmacologic characteristics of CC and EC, discusses the results of clinical trials involving these drugs, and posits implications for their use for clinical practice.

Вторичный гиперпаратиреоз (ВГПТ), часто встречающийся у пациентов, получающих поддерживающий диализ, связан с многочисленными неблагоприятными исходами, включая кальцификацию сосудов и клапанов, изменения в метаболизме костной ткани и повышенный риск сердечно-сосудистых заболеваний и смертности. Кальцимиметики - агенты, действующие на рецептор, чувствительный к кальцию (CaSR), разработаны для преодоления ограничений в использовании стеролов витамина D для лечения ВГПТ и продемонстрировали эффективность в снижении уровней ПТГ в рандомизированных исследованиях. Доступные в настоящее время кальцимиметики включают пероральный цинакальцет (ЦК) и недавно одобренный препарат для внутривенного введения этелкальцетид (эк). в то время как ЦК является аллостерическим модулятором CaSR, эк действует как прямой агонист CaSR. Свойства эк позволяют вводить его внутривенно 3 раза в неделю в конце сеанса лечения гемодиализом, что несомненно повышает приверженность терапии и снижает нагрузку применения таблетированных препаратов. в рандомизированных клинических исследованиях показано, что эк более эффективен, чем ЦК, в снижении уровня ПТГ, фосфатов, кальция, фактора роста фибробластов-23 (ФРФ-23). в этом обзоре сравниваются и сопоставляются фармакологические характеристики ЦК и эк, обсуждаются результаты клинических испытаний с участием этих препаратов и излагаются последствия их использования в клинической практике.

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