Кальцимиметики в лечении вторичного гиперпаратиреоза у диализных пациентов: сравнение эффективности и безопасности цинакальцета и этелкальцетида


DOI: https://dx.doi.org/10.18565/nephrology.2022.1.73-87

Волгина Г.В.

ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» МЗ РФ, Москва, Россия
Вторичный гиперпаратиреоз (ВГПТ), часто встречающийся у пациентов, получающих поддерживающий диализ, связан с многочисленными неблагоприятными исходами, включая кальцификацию сосудов и клапанов, изменения в метаболизме костной ткани и повышенный риск сердечно-сосудистых заболеваний и смертности. Кальцимиметики – агенты, действующие на рецептор, чувствительный к кальцию (CaSR), разработаны для преодоления ограничений в использовании стеролов витамина D для лечения ВГПТ и продемонстрировали эффективность в снижении уровней ПТГ в рандомизированных исследованиях. Доступные в настоящее время кальцимиметики включают пероральный цинакальцет (ЦК) и недавно одобренный препарат для внутривенного введения этелкальцетид (ЭК). В то время как ЦК является аллостерическим модулятором CaSR, ЭК действует как прямой агонист CaSR. Свойства ЭК позволяют вводить его внутривенно 3 раза в неделю в конце сеанса лечения гемодиализом, что несомненно повышает приверженность терапии и снижает нагрузку применения таблетированных препаратов. В рандомизированных клинических исследованиях показано, что ЭК более эффективен, чем ЦК, в снижении уровня ПТГ, фосфатов, кальция, фактора роста фибробластов-23 (ФРФ-23). В этом обзоре сравниваются и сопоставляются фармакологические характеристики ЦК и ЭК, обсуждаются результаты клинических испытаний с участием этих препаратов и излагаются последствия их использования в клинической практике.
Ключевые слова: кальций-чувствительные рецепторы, минеральные и костные нарушения – хроническая болезнь почек (МКН- ХБП), этелкальцетид, кальцимиметики, вторичный гиперпаратиреоз, цинакальцет, гемодиализ
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Об авторах / Для корреспонденции

Волгина Галина Владимировна – д.м.н., профессор, ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» МЗ РФ. Адрес: 127473, Москва, ул. Делегатская 20, корп. 1, Российская Федерация; e-mail: volginagv@mail.ru


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