A comparative analysis of the efficacy and safety of paricalcitol versus other vitamin D receptor activators in patients undergoing hemodialysis: A systematic review and meta-analysis of 15 randomized controlled trials

Abstract

Paricalcitol, a new vitamin D receptor activator (VDRA), is reported to be more effective than other VDRAs in reducing calcium and phosphorus levels in patients undergoing hemodialysis. However, the efficacy and safety of paricalcitol remain controversial. This analysis compares paricalcitol with other VDRAs in patients undergoing hemodialysis. We searched the Cochrane Library, PubMed, EMBASE, Web of Science, and CNKI up to April 22, 2019. Standardized mean difference (SMD), risk ratio (RR) and 95% confidence interval (CI) values were estimated to compare the outcomes of the groups. Two reviewers extracted data and assessed trial quality independently. All statistical analyses were performed using the standard statistical procedures of RevMan 5.2 and Stata 12.0. Fifteen studies (N = 110,544) were included in this meta-analysis. Of these studies, 11 were randomized controlled trials (RCTs) and 4 were non-randomized studies of interventions (NRSIs). Patients receiving paricalcitol experienced better overall survival (OS) than patients receiving other VDRAs, with a pooled hazard ratio of 0.86 (95% CI 0.80-0.91; P < 0.00001). Intact parathyroid hormone (iPTH) levels were significantly reduced in the paricalcitol group compared to the group receiving other VDRAs, with a pooled SMD of -0.53 (95% CI -0.89--0.16; P = 0.004). There was a significant increase in serum calcium levels from baseline in the paricalcitol group compared to the other VDRAs group when limiting the analysis to RCTs, with a pooled SMD of 2.14 (95% CI 0.90-3.38; P = 0.0007). Changes in serum calcium levels were significantly lower in the paricalcitol group when the analysis was limited to NRSIs, with a pooled SMD of -0.85 (95% CI -1.34--0.35; P = 0.0008). The NSRI analysis also showed a significant reduction in serum phosphorus levels in the paricalcitol group, with a pooled SMD of -0.57 (95% CI -1.00--0.13; P = 0.01). No significant differences were observed in the incidence of hypercalcemia, hyperphosphatemia, or adverse events. Generally, paricalcitol seems superior to other VDRAs in reducing mortality and iPTH levels in patients undergoing hemodialysis. However, the comparative effectiveness of paricalcitol in reducing serum calcium and phosphorus levels needs further exploration. No significant difference was found in the rate of adverse events.

Comparison of Paricalcitol (I.V) and Alfacalcidol (I.V) in Treatment of Secondary Hyperparathyroidism (SHPT) in Hemodialysis Patients

“…He also found that paricalcitol has mortality benefits compared to other vitamin D analogs. 8 A randomized multicenter study was conducted by Daniel W Coyne et al in the USA recently which showed that both calcitriol and paricalcitol achieved an effective reduction in parathyroid hormone levels however paricalcitol suppressed iPTH sooner than calcitriol with less incidence of hypercalcemia. 9 This study was carried out in CKD stage 3-4 patients and not in the dialysis population.…”

Paricalcitol in management of chronic kidney disease–mineral and bone disorder

“…В другом метаанализе X. Geng et al (n = 110 544) оценка эффективности парикальцитола проводилась в отдельных подгруппах: 10 РКИ и 4 ретроспективных КИ. Согласно полученным данным парикальцитол также продемонстрировал лучшие результаты в коррекции уровня иПТГ (СРС = -0,53, ДИ 95%: -0,89--0,16; р = 0,004) [20]. Что касается влияния на концентрации кальция в сыворотке крови, то были получены противоречивые результаты.…”

Algoritmo de diagnóstico y tratamiento del hiperparatiroidismo secundario en la enfermedad renal crónica avanzada

“…PTHi / Fosfatasa Alcalina Total (inicial y a los 3-6 m) concentración de fosfatemia, por lo cual se debe corregir esta alteración bioquímica antes de tratar el hiperparatiroidismo secundario a la ERC con vitamina D 46 . Asimismo, la complementación de calcio se ha relacionado con mayor riesgo de calcificación y morbimortalidad en pacientes en diálisis 47 .…”