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Real-World Assessment: Clinical Effectiveness and Safety of Extended-Release Calcifediol.
Am J Nephrol. 2021; 52(10-11):798-807.AJ

Abstract

INTRODUCTION

The safety and efficacy of extended-release calcifediol (ERC) as a treatment for secondary hyperparathyroidism (SHPT) in adults with stage 3 or 4 chronic kidney disease (CKD) and vitamin D insufficiency (VDI) has been demonstrated in prospective randomized clinical trials (RCTs). ERC (Rayaldee®) was approved by the Food and Drug Administration in 2016 on the basis of these prospective RCTs. The current retrospective study assessed the postlaunch data available with respect to ERC's efficacy and safety in increasing serum 25-hydroxyvitamin D (25D) and reducing parathyroid hormone (PTH) in the indicated population.

MATERIALS AND METHODS

Medical records of 174 patients who met study criteria from 15 geographically representative United States nephrology clinics were reviewed for 1 year before and after initiation of ERC treatment. Enrolled subjects had ages ≥18 years, stage 3 or 4 CKD, and a history of SHPT and VDI. Key study variables included patient demographics, medication usage, and laboratory results, including serial 25D and PTH determinations.

RESULTS

The enrolled subjects had a mean age of 69.0 years, gender and racial distributions representative of the indicated population, and were balanced for CKD stage. Most (98%) received 30 mcg of ERC/day during the course of treatment (mean follow-up: 24 weeks). Baseline 25D and PTH levels averaged 20.3 ± 0.7 (standard error) ng/mL and 181 ± 7.4 pg/mL, respectively. ERC treatment raised 25D by 23.7 ± 1.6 ng/mL (p < 0.001) and decreased PTH by 34.1 ± 6.6 pg/mL (p < 0.001) with nominal changes of 0.1 mg/dL (p > 0.05) in serum calcium (Ca) and phosphorus (P) levels.

DISCUSSION/CONCLUSION

Analysis of postlaunch data confirmed ERC's effectiveness in increasing serum 25D and reducing PTH levels without statistically significant or notable impact on serum Ca and P levels. A significant percentage of these subjects achieved 25D levels ≥30 mg/mL and PTH levels which decreased by at least 30% from baseline. Dose titration to 60 mcgs was rarely prescribed. Closer patient monitoring and appropriate dose titration may have led to a higher percentage of subjects achieving an increase in 25D levels to at least 50 ng/mL and a reduction in PTH levels of at least 30%.

Authors+Show Affiliations

California Institute of Renal Research, San Diego, California, USA.Renal Transplant Associates of New England, Springfield, Massachusetts, USA.South Texas Renal Care Group, San Antonio, Texas, USA.BluePath Solutions, Los Angeles, California, USA.BluePath Solutions, Los Angeles, California, USA.BluePath Solutions, Los Angeles, California, USA.OPKO Health, Inc., Miami, Florida, USA.OPKO Health, Inc., Miami, Florida, USA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

34818216

Citation

Fadda, George, et al. "Real-World Assessment: Clinical Effectiveness and Safety of Extended-Release Calcifediol." American Journal of Nephrology, vol. 52, no. 10-11, 2021, pp. 798-807.
Fadda G, Germain MJ, Broumand V, et al. Real-World Assessment: Clinical Effectiveness and Safety of Extended-Release Calcifediol. Am J Nephrol. 2021;52(10-11):798-807.
Fadda, G., Germain, M. J., Broumand, V., Nguyen, A., McGarvey, N., Gitlin, M., Bishop, C. W., & Ashfaq, A. (2021). Real-World Assessment: Clinical Effectiveness and Safety of Extended-Release Calcifediol. American Journal of Nephrology, 52(10-11), 798-807. https://doi.org/10.1159/000518545
Fadda G, et al. Real-World Assessment: Clinical Effectiveness and Safety of Extended-Release Calcifediol. Am J Nephrol. 2021;52(10-11):798-807. PubMed PMID: 34818216.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Real-World Assessment: Clinical Effectiveness and Safety of Extended-Release Calcifediol. AU - Fadda,George, AU - Germain,Michael J, AU - Broumand,Varshasb, AU - Nguyen,Andy, AU - McGarvey,November, AU - Gitlin,Matthew, AU - Bishop,Charles W, AU - Ashfaq,Akhtar, Y1 - 2021/10/27/ PY - 2021/02/23/received PY - 2021/07/16/accepted PY - 2021/11/25/pubmed PY - 2022/3/11/medline PY - 2021/11/24/entrez KW - Extended-release calcifediol KW - Real-world KW - Secondary hyperparathyroidism KW - Vitamin D insufficiency KW - Vitamin D therapy SP - 798 EP - 807 JF - American journal of nephrology JO - Am J Nephrol VL - 52 IS - 10-11 N2 - INTRODUCTION: The safety and efficacy of extended-release calcifediol (ERC) as a treatment for secondary hyperparathyroidism (SHPT) in adults with stage 3 or 4 chronic kidney disease (CKD) and vitamin D insufficiency (VDI) has been demonstrated in prospective randomized clinical trials (RCTs). ERC (Rayaldee®) was approved by the Food and Drug Administration in 2016 on the basis of these prospective RCTs. The current retrospective study assessed the postlaunch data available with respect to ERC's efficacy and safety in increasing serum 25-hydroxyvitamin D (25D) and reducing parathyroid hormone (PTH) in the indicated population. MATERIALS AND METHODS: Medical records of 174 patients who met study criteria from 15 geographically representative United States nephrology clinics were reviewed for 1 year before and after initiation of ERC treatment. Enrolled subjects had ages ≥18 years, stage 3 or 4 CKD, and a history of SHPT and VDI. Key study variables included patient demographics, medication usage, and laboratory results, including serial 25D and PTH determinations. RESULTS: The enrolled subjects had a mean age of 69.0 years, gender and racial distributions representative of the indicated population, and were balanced for CKD stage. Most (98%) received 30 mcg of ERC/day during the course of treatment (mean follow-up: 24 weeks). Baseline 25D and PTH levels averaged 20.3 ± 0.7 (standard error) ng/mL and 181 ± 7.4 pg/mL, respectively. ERC treatment raised 25D by 23.7 ± 1.6 ng/mL (p < 0.001) and decreased PTH by 34.1 ± 6.6 pg/mL (p < 0.001) with nominal changes of 0.1 mg/dL (p > 0.05) in serum calcium (Ca) and phosphorus (P) levels. DISCUSSION/CONCLUSION: Analysis of postlaunch data confirmed ERC's effectiveness in increasing serum 25D and reducing PTH levels without statistically significant or notable impact on serum Ca and P levels. A significant percentage of these subjects achieved 25D levels ≥30 mg/mL and PTH levels which decreased by at least 30% from baseline. Dose titration to 60 mcgs was rarely prescribed. Closer patient monitoring and appropriate dose titration may have led to a higher percentage of subjects achieving an increase in 25D levels to at least 50 ng/mL and a reduction in PTH levels of at least 30%. SN - 1421-9670 UR - https://www.unboundmedicine.com/medline/citation/34818216/Real_World_Assessment:_Clinical_Effectiveness_and_Safety_of_Extended_Release_Calcifediol_ L2 - https://www.karger.com?DOI=10.1159/000518545 DB - PRIME DP - Unbound Medicine ER -