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Published in: Clinical and Experimental Nephrology 2/2019

Open Access 01-02-2019 | Original article

Pharmacodynamics of evocalcet for secondary hyperparathyroidism in Japanese hemodialysis patients

Authors: Takashi Shigematsu, Ryutaro Shimazaki, Masafumi Fukagawa, Tadao Akizawa, Evocalcet Study Group

Published in: Clinical and Experimental Nephrology | Issue 2/2019

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Abstract

Background

This study investigated the pharmacokinetics, pharmacodynamics, and safety of multiple doses of evocalcet in Japanese secondary hyperparathyroidism (SHPT) patients receiving hemodialysis.

Methods

In this multicenter, open-label study, conducted between August 2013 and March 2014, 27 patients received multiple doses of 1 and 4 mg evocalcet for 14 days, followed by an extension period of multiple doses of 8 and 12 mg evocalcet for 7 days using an intra-patient dose escalation protocol. Pharmacodynamic parameters consisted of measurement of intact parathyroid hormone (PTH), serum-corrected calcium, serum phosphorus and intact fibroblast growth factor 23 concentrations. Safety was assessed by analysis of adverse events.

Results

Plasma evocalcet levels reached steady state 3 days after the first day of administration. Pharmacodynamic analyses showed that evocalcet effectively reduced intact PTH and serum-corrected calcium levels. Adverse events (AEs) occurred in 29.6 and 62.5% of patients receiving multiple doses of 1 or 4 mg, respectively. The AE ‘blood calcium decreased’ occurred in eight patients (33.0%) after multiple doses of 4 mg. All events were mild, except for one patient with a moderate AE (abnormal liver function) and one patient with a severe adverse drug reaction (blood calcium decreased).

Conclusion

Multiple doses of evocalcet reduced intact PTH levels with a concomitant decrease in serum calcium levels. Evocalcet was well tolerated in SHPT patients receiving hemodialysis.
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Literature
1.
go back to reference Komaba H, Kakuta T, Fukagawa M. Diseases of the parathyroid gland in chronic kidney disease. Clin Exp Nephrol. 2011;15:797–809.CrossRefPubMed Komaba H, Kakuta T, Fukagawa M. Diseases of the parathyroid gland in chronic kidney disease. Clin Exp Nephrol. 2011;15:797–809.CrossRefPubMed
2.
go back to reference Drueke TB. Cell biology of parathyroid gland hyperplasia in chronic renal failure. J Am Soc Nephrol. 2000;11:1141–52.PubMed Drueke TB. Cell biology of parathyroid gland hyperplasia in chronic renal failure. J Am Soc Nephrol. 2000;11:1141–52.PubMed
3.
go back to reference Elder G. Pathophysiology and recent advances in the management of renal osteodystrophy. J Bone Miner Res. 2002;17:2094–105.CrossRefPubMed Elder G. Pathophysiology and recent advances in the management of renal osteodystrophy. J Bone Miner Res. 2002;17:2094–105.CrossRefPubMed
4.
go back to reference Torres A, Lorenzo V, Hernandez D, et al. Bone disease in predialysis, hemodialysis, and CAPD patients: evidence of a better bone response to PTH. Kidney Int. 1995;47:1434–42.CrossRefPubMed Torres A, Lorenzo V, Hernandez D, et al. Bone disease in predialysis, hemodialysis, and CAPD patients: evidence of a better bone response to PTH. Kidney Int. 1995;47:1434–42.CrossRefPubMed
5.
go back to reference Slatopolsky E, Brown A, Dusso A. Pathogenesis of secondary hyperparathyroidism. Kidney Int Suppl. 1999;73:14–9.CrossRef Slatopolsky E, Brown A, Dusso A. Pathogenesis of secondary hyperparathyroidism. Kidney Int Suppl. 1999;73:14–9.CrossRef
6.
go back to reference Cunningham J, Locatelli F, Rodriguez M. Secondary hyperparathyroidism: pathogenesis, disease progression, and therapeutic options. Clin J Am Soc Nephrol. 2011;6:913–21.CrossRef Cunningham J, Locatelli F, Rodriguez M. Secondary hyperparathyroidism: pathogenesis, disease progression, and therapeutic options. Clin J Am Soc Nephrol. 2011;6:913–21.CrossRef
7.
go back to reference Block GA, Klassen PS, Lazarus JM, et al. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004;15:2208–18.CrossRef Block GA, Klassen PS, Lazarus JM, et al. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004;15:2208–18.CrossRef
8.
go back to reference Martin KJ, Gonzalez EA. Metabolic bone disease in chronic kidney disease. J Am Soc Nephrol. 2007;18:875–85.CrossRefPubMed Martin KJ, Gonzalez EA. Metabolic bone disease in chronic kidney disease. J Am Soc Nephrol. 2007;18:875–85.CrossRefPubMed
9.
go back to reference Komaba H, Fukagawa M, Group KRNS. Impact of cinacalcet hydrochloride on the achievement of the Japanese Society for Dialysis Therapy (JSDT) guideline targets: a post-hoc analysis of the KRN1493 study. Ther Apher Dial. 2008;12(Suppl 1):44–9.CrossRef Komaba H, Fukagawa M, Group KRNS. Impact of cinacalcet hydrochloride on the achievement of the Japanese Society for Dialysis Therapy (JSDT) guideline targets: a post-hoc analysis of the KRN1493 study. Ther Apher Dial. 2008;12(Suppl 1):44–9.CrossRef
10.
go back to reference Charytan C, Coburn JW, Chonchol M, et al. Cinacalcet hydrochloride is an effective treatment for secondary hyperparathyroidism in patients with CKD not receiving dialysis. Am J Kidney Dis. 2005;46:58–67.CrossRefPubMed Charytan C, Coburn JW, Chonchol M, et al. Cinacalcet hydrochloride is an effective treatment for secondary hyperparathyroidism in patients with CKD not receiving dialysis. Am J Kidney Dis. 2005;46:58–67.CrossRefPubMed
11.
go back to reference Chonchol M, Locatelli F, Abboud HE, et al. A randomized, double-blind, placebo-controlled study to assess the efficacy and safety of cinacalcet HCl in participants with CKD not receiving dialysis. Am J Kidney Dis. 2009;53:197–207.CrossRefPubMed Chonchol M, Locatelli F, Abboud HE, et al. A randomized, double-blind, placebo-controlled study to assess the efficacy and safety of cinacalcet HCl in participants with CKD not receiving dialysis. Am J Kidney Dis. 2009;53:197–207.CrossRefPubMed
12.
go back to reference Palmer SC, Nistor I, Craig JC, et al. Cinacalcet in patients with chronic kidney disease: a cumulative meta-analysis of randomized controlled trials. PLoS Med. 2013;10(4):e1001436.CrossRefPubMedPubMedCentral Palmer SC, Nistor I, Craig JC, et al. Cinacalcet in patients with chronic kidney disease: a cumulative meta-analysis of randomized controlled trials. PLoS Med. 2013;10(4):e1001436.CrossRefPubMedPubMedCentral
13.
go back to reference Kawata T, Tokunaga S, Murai M, et al. A novel calcimimetic agent, evocalcet (MT-4580/KHK7580), suppresses the parathyroid cell function with little effect on the gastrointestinal tract or CYP isozymes in vivo and in vitro. PLoS One. 2018;13(4):e0195316.CrossRefPubMedPubMedCentral Kawata T, Tokunaga S, Murai M, et al. A novel calcimimetic agent, evocalcet (MT-4580/KHK7580), suppresses the parathyroid cell function with little effect on the gastrointestinal tract or CYP isozymes in vivo and in vitro. PLoS One. 2018;13(4):e0195316.CrossRefPubMedPubMedCentral
14.
go back to reference Shigematsu T, Shimazaki R, Fukagawa M, et al. Pharmacokinetics of evocalcet in secondary hyperparathyroidism patients receiving hemodialysis: first-in-patient clinical trial in Japan. Adv Clin Pharmacol Appl. 2018 Shigematsu T, Shimazaki R, Fukagawa M, et al. Pharmacokinetics of evocalcet in secondary hyperparathyroidism patients receiving hemodialysis: first-in-patient clinical trial in Japan. Adv Clin Pharmacol Appl. 2018
15.
go back to reference Ohashi N, Uematsu T, Nagashima S, et al. The calcimimetic agent KRN 1493 lowers plasma parathyroid hormone and ionized calcium concentrations in patients with chronic renal failure on haemodialysis both on the day of haemodialysis and on the day without haemodialysis. Br J Clin Pharmacol. 2004;57:726–34.CrossRefPubMedPubMedCentral Ohashi N, Uematsu T, Nagashima S, et al. The calcimimetic agent KRN 1493 lowers plasma parathyroid hormone and ionized calcium concentrations in patients with chronic renal failure on haemodialysis both on the day of haemodialysis and on the day without haemodialysis. Br J Clin Pharmacol. 2004;57:726–34.CrossRefPubMedPubMedCentral
16.
go back to reference Akiba T, Akizawa T, Tsukamoto Y, et al. Dose determination of cinacalcet hydrochloride in Japanese hemodialysis patients with secondary hyperparathyroidism. Ther Apher Dial. 2008;12:117–25.CrossRefPubMed Akiba T, Akizawa T, Tsukamoto Y, et al. Dose determination of cinacalcet hydrochloride in Japanese hemodialysis patients with secondary hyperparathyroidism. Ther Apher Dial. 2008;12:117–25.CrossRefPubMed
17.
go back to reference Yokoyama K, Fukagawa M, Shigematsu T, et al. A 12-week dose-escalating study of etelcalcetide (ONO-5163/AMG 416), a novel intravenous calcimimetic, for secondary hyperparathyroidism in Japanese hemodialysis patients. Clin Nephrol. 2017;88:68–78.CrossRefPubMed Yokoyama K, Fukagawa M, Shigematsu T, et al. A 12-week dose-escalating study of etelcalcetide (ONO-5163/AMG 416), a novel intravenous calcimimetic, for secondary hyperparathyroidism in Japanese hemodialysis patients. Clin Nephrol. 2017;88:68–78.CrossRefPubMed
18.
go back to reference Borrego-Utiel FJ, Perez-del Barrio Mdel P, Biechy-Baldan Mdel M, et al. Cinacalcet may prolong the QT interval in patients on haemodialysis with secondary hyperparathyroidism. Nefrologia. 2013;33:272–3.PubMed Borrego-Utiel FJ, Perez-del Barrio Mdel P, Biechy-Baldan Mdel M, et al. Cinacalcet may prolong the QT interval in patients on haemodialysis with secondary hyperparathyroidism. Nefrologia. 2013;33:272–3.PubMed
19.
go back to reference Temiz G, Yalcin AU, Mutluay R, et al. Effects of cinacalcet treatment on QT interval in hemodialysis patients. Anatol J Cardiol. 2016;16(7):520–3.PubMed Temiz G, Yalcin AU, Mutluay R, et al. Effects of cinacalcet treatment on QT interval in hemodialysis patients. Anatol J Cardiol. 2016;16(7):520–3.PubMed
Metadata
Title
Pharmacodynamics of evocalcet for secondary hyperparathyroidism in Japanese hemodialysis patients
Authors
Takashi Shigematsu
Ryutaro Shimazaki
Masafumi Fukagawa
Tadao Akizawa
Evocalcet Study Group
Publication date
01-02-2019
Publisher
Springer Singapore
Published in
Clinical and Experimental Nephrology / Issue 2/2019
Print ISSN: 1342-1751
Electronic ISSN: 1437-7799
DOI
https://doi.org/10.1007/s10157-018-1635-6

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