Comparison between paricalcitol and active non-selective vitamin D receptor activator for secondary hyperparathyroidism in chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials

@article{Cai2015ComparisonBP,
  title={Comparison between paricalcitol and active non-selective vitamin D receptor activator for secondary hyperparathyroidism in chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials},
  author={Panpan Cai and Xiao-hong Tang and Wei Qin and Ling Ji and Zi Li},
  journal={International Urology and Nephrology},
  year={2015},
  volume={48},
  pages={571-584}
}
PurposeThe goal of this systematic review is to evaluate the efficacy and safety of paricalcitol versus active non-selective vitamin D receptor activators (VDRAs) for secondary hyperparathyroidism (SHPT) management in chronic kidney disease (CKD) patients.MethodsPubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), clinicaltrials.gov (inception to September 2015), and ASN Web site were searched for relevant studies. A meta-analysis of randomized controlled trials (RCTs) and… 

Comparative efficacy and safety of paricalcitol versus vitamin D receptor activators for dialysis patients with secondary hyperparathyroidism: a meta-analysis of randomized controlled trials

Evidence is insufficient to draw a conclusion regarding whether paricalcitol therapy has a comparative efficacy and safety over other VDRAs for treating dialysis patients with SHPT, and large-sample, well-conducted, high-quality RCTs with patient-level outcomes are urgently needed.

PHARMACOECONOMICS OF ORAL PARICALCITOL THERAPY IN PATIENTS WITH A CHRONIC KIDNEY DISEASE AND SECONDARY HYPERPARATHYROIDISM

Oral paricalcitol therapy in patients with a CKD and secondary hyperparathyroidism, according to results of modeling, allows to postpone transition of patients to dialysis and, taking into account the made assumptions, can be considered in Patients with early stages of a nephropathy as economically acceptable intervention.

A Bayesian network analysis on comparative efficacy of treatment strategies for dialysis patients with secondary hyperparathyroidism.

According to a ranking analysis, patients treated with cinacalcet had a higher possibility of frequently developing nausea and hypocalcaemia compared with patientstreated with c inacalCet plus low-dose active vitamin D analogues, and paricalcitol therapy may be the most optimal regimen in controlling PTH levels.

Alfacalcidol in CKD-MBDA Fresh Look

Alfacalcidol was the first vitamin D analog produced in the 1970’s, available for treatment of renal osteodystrophy in all stages of CKD and has been used in most European countries since then, either alone or in combination with calcimimetics or bisphosphonates and shown to attenuate all aspects of CKd-MBD.

Comparison of Paricalcitol (I.V) and Alfacalcidol (I.V) in Treatment of Secondary Hyperparathyroidism (SHPT) in Hemodialysis Patients

Alfacalcidol can be a better choice when treating SHPT as it did not find any gross difference in the ability of two drugs to restrict SHPT, and Paricalcitol is expensive as compared to alfacalcodol, in an economically challenged country like Pakistan.

Clinical practice recommendations for treatment with active vitamin D analogues in children with chronic kidney disease Stages 2-5 and on dialysis.

  • R. ShroffM. Wan C. Schmitt
  • Medicine, Biology
    Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
  • 2017
A core working group of the European Society for Paediatric Nephrology CKD-MBD and Dialysis WGs has developed recommendations for the use of active vitamin D therapy in children with CKD and on dialysis and the Grading of Recommendation, Assessment, Development and Evaluation system was used to develop and grade the recommendations.

Parathyroidectomy improves overall survival in hemodialysis patients with severe secondary hyperparathyroidism : a two-year ’ s follow-up result

PTX could dramatically improve overall survival independently in hemodialysis patients with severe sHPT, and high FGF-23 expression could be served as a biomarker for poor prognosis.

Secondary Hyperparthyroidism: Pathogenesis, Diagnosis, Preventive and Therapeutic Strategies

An update of the leading therapeutic tools available for the prevention and clinical management of secondary hyperparathyroidism, its diagnosis, and the main mechanisms and factors involved in the pathogenesis of the disease will be described in this review.

Vitamin D Deficiency in Children with Chronic Kidney Disease

Abbreviations: 1,25(OH)2D: calcitriol; 7-DHC: 7-dehydrocholesterol; 25(OH)D: 25-hydroxyvitamin D; BMD: bone mineral density; CKD: chronic kidney disease; CKD-MBDCKD: Mineral and Bone Disorder; CYP2R1

Treatment of Hyperparathyroidism (SHPT)

For patients with PTH progressively elevated, even if within the target level, or above 9 times the reference value for the method, Ca and P control measures and the use of vitamin D analogues and/or calcimimetics should be implemented.

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It is found that paricalcitol suppresses iPTH and lowers proteinuria in patients with stage 2-5 CKD without an increased risk of adverse events, and a trend toward increased hypercalcemia did not reach statistical significance, but may be clinically relevant.

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Although Paricalcitol is effective in lowering PTH, the current meta-analysis uncovered a safety signal identifying an elevated calcium phosphate product and a trend towards the development of hypercalcemia, and advises caution in the use of any active Vitamin D analogues in patients with CKD because of the potential risk of exacerbating vascular calcification.

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Overall, alfacalcidol and paricalcitol are equal candidates for treatment of disturbances in mineral metabolism in hemodialysis patients, and baseline FGF23 is found to predict PTH levels after 16 weeks of vitamin D analog treatment.

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Paricalcitol treatment reduced PTH concentrations more rapidly with fewer sustained episodes of hypercalcemia and increased Ca x P product than calcitriol therapy.

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Oral paricalcitol is effective in decreasing posttransplant hyperparathyroidism and may have beneficial effects on renal allograft histology.

Effect of Paricalcitol vs Calcitriol on Hemoglobin Levels in Chronic Kidney Disease Patients: A Randomized Trial

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A 2-year single-center study comparing long-term calcitriol with paricalcitol treatment in the same HD patients offers new information regarding single episodes of potentially adverse biochemical effects related to vitamin D therapy, and provides several clues that may explain the outcome advantages suggested by previously published retrospective analyses of large dialysis provider-pooled databases.

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Paricalcitol was found to be effective in reducing iPTH levels in calcitriol-resistant patients with SHPT despite relatively frequent drug discontinuation rates.
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