Etelcalcetide

Etelcalcetide is a calcimimetic agent used to treat secondary hyperparathyroidism in adults receiving hemodialysis. It is a synthetic peptide administered by intravenous injection, typically at the end of a dialysis session.

Mechanism of action: Etelcalcetide activates the calcium-sensing receptor on parathyroid cells, increasing their sensitivity to extracellular calcium. This suppresses parathyroid hormone (PTH) secretion, helping to lower elevated PTH levels associated with chronic kidney disease and dialysis.

Indications and administration: It is indicated for adults with secondary hyperparathyroidism undergoing hemodialysis. The drug is given intravenously three times weekly after dialysis. Dosing is individualized and adjusted based on PTH, calcium, and phosphate levels; starting doses are commonly titrated up or down to achieve target laboratory values.

Pharmacokinetics: Etelcalcetide is a peptide that is rapidly degraded by proteolysis to inactive metabolites. It is not orally bioavailable and is eliminated primarily through proteolytic metabolism, with minimal reliance on renal excretion. Dialysis sessions are coordinated with administration, and the drug is given after dialysis.

Safety and adverse effects: Common adverse effects include hypocalcemia, nausea, vomiting, diarrhea, and headache. Hypocalcemia is a major safety consideration and requires regular monitoring of serum calcium, with adjustments to vitamin D analogs, phosphate binders, or dosing as needed. Hypersensitivity reactions and injection-site reactions may occur.

Interactions and contraindications: Cautions apply for patients with preexisting hypocalcemia or those receiving other agents that lower calcium. Contraindications include hypersensitivity to etelcalcetide or its components. Individualized monitoring is recommended when used with other therapies affecting calcium and mineral metabolism.

History and status: Etelcalcetide was developed by Amgen and approved for use in adults on dialysis in the mid-2010s and is marketed under the brand Parsabiv.