次發性副甲狀腺機能亢進是慢性腎臟病常見的併發症之一，會導致骨質轉換增 加及血管鈣化，也與骨折風險、心血管疾病風險及整體死亡率相關。傳統治療包括 磷結合劑、活性維生素 D 及擬鈣劑 cinacalcet。活性維生素 D 雖可抑制副甲狀腺素 (parathyroid hormone, PTH) 分泌，但也會促進腸道鈣磷的吸收。Cinacalcet 可有效 降低 PTH 及鈣磷，然而服藥順從性不佳成為治療的一大挑戰。新上市的針劑擬鈣劑 etelcalcetide 效果不劣於 cinacalcet，且可減少病人口服藥物顆數及改善 cinacalcet 服 藥順從性不佳的問題。但要注意的是，低血鈣的發生率較高，更需密切監測。

 

Secondary hyperparathyroidism is a common complication of chronic kidney disease. It accelerates bone turnover and increases the risk of fractures and vascular calcification. In addition, it is associated with increased cardiovascular and allcause mortality. Traditional treatments include phosphate binders, active vitamin D compounds, and the calcimimetic, cinacalcet. Although active vitamin D compoundscan inhibit the secretion of parathyroid hormone (PTH), it also promotes the absorption of calcium and phosphate in the intestines. Cinacalcet can effectively reduce PTH, calcium, and phosphorus, but poor adherence is a major challenge for treatment. Etelcalcetide, an intravenous calcimimetic agent, is non-inferior to cinacalcet in reducing PTH levels, and it reduces pill burden and enhances drug adherence. However, etelcalcetide leads to more frequent episodes of hypocalcemia, and therefore, close monitoring is required.

 

Summited for publication: 2021.6.1; Accepted for publication: 2021.10.6