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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):798-807doi: 10.1159/000518545.
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), 798-807. https://doi.org/10.1159/000518545
Fadda, George, et al. "Real-World Assessment: Clinical Effectiveness and Safety of Extended-Release Calcifediol." American journal of nephrology vol. 52,10 (2021): 798-807. doi: https://doi.org/10.1159/000518545
Fadda G, Germain MJ, Broumand V, Nguyen A, McGarvey N, Gitlin M, Bishop CW, Ashfaq A. Real-World Assessment: Clinical Effectiveness and Safety of Extended-Release Calcifediol. Am J Nephrol. 2021;52(10):798-807. doi: 10.1159/000518545. Epub 2021 Oct 27. PMID: 34818216.
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Am J Nephrol. 2021;52(10):798-807. doi: 10.1159/000518545. Epub 2021 Oct 27.

Real-World Assessment: Clinical Effectiveness and Safety of Extended-Release Calcifediol.

American journal of nephrology

George Fadda, Michael J Germain, Varshasb Broumand, Andy Nguyen, November McGarvey, Matthew Gitlin, Charles W Bishop, Akhtar Ashfaq

Affiliations

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

PMID: 34818216 DOI: 10.1159/000518545

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%.

© 2021 S. Karger AG, Basel.

Keywords: Extended-release calcifediol; Real-world; Secondary hyperparathyroidism; Vitamin D insufficiency; Vitamin D therapy

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