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Medical Industry Feature: Dosing Practices in Secondary Hyperparathyroidism

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Dosing Practices in sHPT

Dosing Practices in sHPT
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Nephrology prescribers discuss a dosing practice involving a treatment option for sHPT.

  • Overview

    How can you control the administration of calcimimetics for your patients with chronic kidney disease who are on hemodialysis and suffering from secondary hyperparathyroidism, also known as sHPT? John Russell, MD sits down with two community nephrology professionals, Adbul Abdellatif, MD, FASN from Houston, Texas, and Debbie Glidden, MSN, APRN-BC, CNN from Orlando, Florida. They will be discussing a dosing practice involving oral cinacalcet and what alternatives they suggest for nephrologists who are concerned about controlling the administration of sHPT treatment in an approved fashion.

    This promotional, non-CME program is intended for US Health Care Professionals. Adbul Abdellatif, MD, FASN and Debbie Glidden, MSN, APRN-BC, CNN were paid a fee by Amgen for their participation in the program.

  • INDICATION

    • Parsabiv® (etelcalcetide) is indicated for the treatment of secondary hyperparathyroidism (HPT) in adult patients with chronic kidney disease (CKD) on hemodialysis.
    • Sensipar® (cinacalcet) is indicated for the treatment of secondary HPT in adult patients with CKD on dialysis.

    Limitations of Use:

    • Parsabiv® has not been studied in adult patients with parathyroid carcinoma, primary hyperparathyroidism, or with CKD who are not on hemodialysis and is not recommended for use in these populations.
    • Sensipar® is not indicated for use in patients with CKD who are not on dialysis because of an increased risk of hypocalcemia.
  • IMPORTANT SAFETY INFORMATION

    Contraindications:

    • Parsabiv® is contraindicated in patients with known hypersensitivity to etelcalcetide or any of its excipients. Hypersensitivity reactions, including face edema and anaphylactic reaction, have occurred.
    • Sensipar® treatment initiation is contraindicated if serum calcium is less than the lower limit of the normal range (8.4 mg/dL).

    Hypocalcemia:

    • Parsabiv® and Sensipar® lower serum calcium and can lead to hypocalcemia, sometimes severe. Life threatening events and fatal outcomes associated with hypocalcemia have been reported in patients treated with Sensipar®, including pediatric patients. The safety and effectiveness of Sensipar® have not been established in pediatric patients.
    • Significant lowering of serum calcium can cause QT interval prolongation and ventricular arrhythmia. Cases of QT prolongation and ventricular arrhythmia have been reported in patients treated with Sensipar®. Patients with conditions that predispose to QT interval prolongation and ventricular arrhythmia may be at increased risk for QT interval prolongation and ventricular arrhythmias if they develop hypocalcemia due to Parsabiv® or Sensipar®. Closely monitor corrected serum calcium and QT interval in patients at risk on Parsabiv® or Sensipar®.
    • Significant reductions in corrected serum calcium may lower the threshold for seizures. Patients with a history of seizure disorder may be at increased risk for seizures if they develop hypocalcemia due to Parsabiv® or Sensipar®. Monitor corrected serum calcium in patients with seizure disorders on Parsabiv® or Sensipar®.
    • Concurrent administration of Parsabiv® or Sensipar® with calcium-lowering drugs including other calcimimetics could result in severe, life-threatening hypocalcemia. Parsabiv® and Sensipar® should not be given together. Patients switching from Sensipar® to Parsabiv® should discontinue Sensipar® for at least 7 days prior to initiating Parsabiv®. Closely monitor corrected serum calcium in patients receiving Parsabiv® or Sensipar® and concomitant therapies known to lower serum calcium.
    • Measure corrected serum calcium prior to initiation of Parsabiv®. Do not initiate in patients if the corrected serum calcium is less than the lower limit of normal. Monitor corrected serum calcium within 1 week after initiation or dose adjustment and every 4 weeks during treatment with Parsabiv®. Measure PTH 4 weeks after initiation or dose adjustment of Parsabiv®. Once the maintenance dose has been established, measure PTH per clinical practice.
    • Serum calcium and serum phosphorus should be measured within 1 week and PTH should be measured 1 to 4 weeks after initiation or dose adjustment of Sensipar®. Once the maintenance dose has been established, serum calcium and serum phosphorus should be measured approximately monthly, and PTH every 1 to 3 months.

    Hypotension, Worsening Heart Failure and/or Arrhythmias:

    • In Parsabiv® clinical studies, cases of hypotension, congestive heart failure, and decreased myocardial performance have been reported. Closely monitor patients treated with Parsabiv® for worsening signs and symptoms of heart failure.
    • In Sensipar® postmarketing use, isolated, idiosyncratic cases of hypotension, worsening heart failure, and/or arrhythmia were reported in patients with impaired cardiac function. The causal relationship to Sensipar® therapy could not be completely excluded and may be mediated by reductions in serum calcium levels.

    Upper Gastrointestinal Bleeding:

    • Cases of gastrointestinal (GI) bleeding, mostly upper GI bleeding, have occurred in patients using calcimimetics, including Sensipar®, from postmarketing and clinical trial sources.
    • In clinical studies, 2 patients treated with Parsabiv® in 1253 patient years of exposure had upper GI bleeding at the time of death. There were too few cases to determine whether these cases were related to Parsabiv®.
    • The exact cause of GI bleeding in these patients is unknown. Patients with risk factors for upper GI bleeding, such as known gastritis, esophagitis, ulcers or severe vomiting, may be at increased risk for GI bleeding with Parsabiv® or Sensipar®. Monitor patients for worsening of common Parsabiv® or Sensipar® GI adverse reactions and for signs and symptoms of GI bleeding and ulcerations during Parsabiv® or Sensipar® therapy.

    Adynamic Bone:

    • Adynamic bone may develop if PTH levels are chronically suppressed.

    Adverse Reactions:

    • In clinical trials of patients with secondary HPT comparing Parsabiv® to placebo, the most common adverse reactions were blood calcium decreased (64% vs. 10%), muscle spasms (12% vs. 7%), diarrhea (11% vs. 9%), nausea (11% vs. 6%), vomiting (9% vs. 5%), headache (8% vs. 6%), hypocalcemia (7% vs. 0.2%), and paresthesia (6% vs. 1%).
    • In clinical trials of patients with secondary HPT comparing Sensipar® to placebo, the most commonly reported side effects were nausea (31% vs. 19%), vomiting (27% vs. 15%), and diarrhea (21% vs. 20%).

    Please click here to see accompanying Parsabiv® full prescribing information.

    Please click here here to see accompanying Sensipar® full prescribing information.

    Visit ParsabivHCP.com and SensiparHCP.com for more information.

  • REFERENCES

    1. Sensipar® (cinacalcet) prescribing information, Amgen.
    2. Data on file, Amgen; [US-DOPPS Dialysis chain subanalysis; 2019].
    3. Parsabiv® (etelcalcetide) prescribing information, Amgen.
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