Etelcalcetide: What we know eight years since its approval

Abstract

Introduction and Objectives: The impact of etelcalcetide on patients with chronic kidney disease (CKD) and secondary hyperparathyroidism (SHPT) has been studied since its introduction in 2016/2017. However, only a handful of studies reported clinically relevant outcomes. Thus, this narrative review aims to summarize the published data about etelcalcetide, focusing on biochemical, cardiovascular and bone endpoints, as well as adverse effects and all-cause mortality. Materials and Methods: A literature review of the use of etelcalcetide in hemodialysis patients with SHPT was conducted. Several sources were used, such as PubMed, Google Scholar and Cochrane Library. Results: Regarding bone and mineral metabolism, etelcalcetide is effective in reducing serum levels of parathormone (PTH), calcium, phosphorus and fibroblast growth factor 23 (FGF23). Studies in rats and humans have highlighted its role in reducing bone turnover and improving mineralization and preservation of bone structure, indicating a possible positive impact on renal osteodystrophy. From a cardiovascular (CV) perspective, etelcalcetide is associated with a significant reduction in left ventricular hypertrophy. The impact of etelcalcetide on markers, such as FGF23 and sclerostin, suggests a potential beneficial effect at this level. Conclusions: Etelcalcetide is effective in controlling serum levels of PTH, calcium, phosphorus and FGF23, which may have beneficial effects regarding bone disease and associated fractures. Etelcalcetide reduces left ventricular hypertrophy and has an impact on FGF23 and sclerostin levels, suggesting a possible beneficial CV effect. There is a lack of studies specifically designed to evaluate its role in reducing fractures, CV and all-cause mortality.