From the Guidelines
For patients experiencing gastrointestinal upset with cinacalcet, etelcalcetide (Parsabiv) is a recommended alternative, as it is administered intravenously during hemodialysis, thus avoiding GI side effects 1. When considering alternatives to cinacalcet due to gastrointestinal upset, it's essential to weigh the benefits and risks of each option. Etelcalcetide, a calcimimetic agent like cinacalcet, offers a similar mechanism of action but with the advantage of intravenous administration, bypassing gastrointestinal side effects.
- Other alternatives include:
- Vitamin D analogs such as calcitriol, paricalcitol, or doxercalciferol, which manage secondary hyperparathyroidism through a different mechanism.
- Phosphate binders like sevelamer, lanthanum, or calcium-based products, which indirectly help by controlling phosphate levels.
- Parathyroidectomy, considered for severe, medication-resistant hyperparathyroidism. These options work differently than cinacalcet, an oral calcimimetic that increases calcium receptor sensitivity. The choice of alternative should be made in consultation with a healthcare provider to ensure appropriate management of calcium and parathyroid hormone levels, considering the specific condition being treated, whether primary or secondary hyperparathyroidism related to kidney disease 1.
From the FDA Drug Label
2.4 Switching from Parsabiv (etelcalcetide) to Cinacalcet The FDA drug label mentions Parsabiv (etelcalcetide) as an alternative to Cinacalcet.
- Parsabiv (etelcalcetide) can be considered as an alternative for patients experiencing GI upset with Cinacalcet 2.
From the Research
Alternative to Cincalcet
- Etelcalcetide is an alternative to cinacalcet, as shown in a study 3 that compared the efficacy and safety of etelcalcetide and cinacalcet in patients receiving hemodialysis with secondary hyperparathyroidism.
- Etelcalcetide was found to be noninferior to cinacalcet in reducing serum parathyroid hormone concentrations, and it also met superiority criteria 3.
- Another study 4 reported the integrated safety profile of etelcalcetide using pooled data from five pivotal clinical trials, and found that etelcalcetide had a favorable risk/benefit profile, with safety similar to that of cinacalcet.
Reducing Gastrointestinal Upset
- Administering cinacalcet with the first main meal after dialysis was found to be as effective as administration with food during the dialysis session, and was associated with a lower incidence of gastrointestinal adverse events 5.
- A combined post-hoc analysis of both groups in the same study showed that the incidence of nausea and vomiting was lower when cinacalcet was administered in the evening 5.
- Etelcalcetide, being an intravenously administered calcimimetic, may reduce the risk of gastrointestinal upset compared to oral cinacalcet, as it bypasses the gastrointestinal tract altogether 3, 4.