Этелкальцетид в лечении вторичного гиперпаратиреоза у пациентов на программном гемодиализе: обзор клинических данных и место в терапии


DOI: https://dx.doi.org/10.18565/nephrology.2020.2.74-83

Г.В. Волгина, Н.А. Михайлова

1) ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» МЗ РФ, Москва, Россия; 2) ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» МЗ РФ, кафедра нефрологии и гемодиализа, Москва, Россия
Вторичный гиперпаратиреоз (ВГПТ) широко распространен среди пациентов, получающих поддерживающий гемодиализ (ПГД), и связан с неблагоприятными исходами. В настоящее время тактика лечения ВГПТ заключается в снижении уровня циркулирующего фосфата с помощью пероральных фосфат-связывающих препаратов и в снижении уровня паратиреоидного гормона (ПТГ) с помощью кальцимиметиков – цинакальцета (ЦК), этелкальцетида (ЭК) – и/или аналогов витамина D.
В данной статье представлен краткий обзор патогенеза ВГПТ при хронической болезни почек (ХБП), при этом особое внимание уделено основным молекулярным регуляторам, на которые действуют кальцимиметики. Этелкальцетид представляет собой новый внутривенный кальцимиметик третьей генерации, эффективно снижавший уровень ПТГ в клинических исследованиях при введении 3 раза в неделю. Помимо повышенной приверженности лечению для ЭК характерна более высокая, чем у ЦК, эффективность в подавлении секреции ПТГ. Дополнительные клинические эффекты этого препарата включают снижение уровня циркулирующего фосфата и FGF-23, благоприятное влияние на маркеры костного обмена. Однако, несмотря на в/в введение ЭК, частота случаев тошноты и рвоты при его применении, по-видимому, сходна с таковой для ЦК. Вероятно, этелкальцетид может применяться в лечении ГД пациентов с тяжелым ВГПТ или с гиперкальциемией или гиперфосфатемией, получающих активные метаболиты витамина D. Однако его использование должно как минимум частично ограничиваться из-за риска гипокальциемии и возможного удлинения электрокардиографического интервала QT у пациентов, исходно имеющих низкий уровень кальция и нарушения сердечной проводимости. Обладая эффективностью в качестве препарата для снижения уровня ПТГ, ЭК представляет собой новый, потенциально перспективный терапевтический подход к лечению ВГПТ у пациентов на ПГД. Статья обобщает имеющиеся на сегодня данные о результатах клинических исследований нового внутривенного кальцимиметика третьего поколения.
Ключевые слова: этелкальцетид, кальцимиметик, диализ, вторичный гиперпаратиреоз, хроническая болезнь почек
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Об авторах / Для корреспонденции

Волгина Галина Владимировна – д.м.н., проф. кафедры нефрологии ФПДО ФГБОУ ВО МГМСУ им. А.И. Евдокимова МЗ РФ; Москва, Россия. E-mail: volginagv@mail.ru
Михайлова Наталия Алексеевна – к.м.н., доцент кафедры нефрологии и гемодиализа ГБОУ ДПО РМАНПО МЗ РФ; Москва, Россия.
Е-mail: natmikhailova@mail.ru


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