Skip to main navigationSkip to main content
The University of Southampton
Southampton Health Technology Assessments CentreNews

Treatment of secondary hyperparathyroidism in chronic kidney disease – SHTAC is critically appraising the company’s submission to NICE on new drug etelcalcetide

Published: 18 November 2016
Patient receiving dialysis
Nearly all people with end-stage chronic kidney disease have secondary hyperparathyroidism

SHTAC is assessing the company’s evidence submission to the National Institute for Health and Care Excellence on the clinical and cost-effectiveness of etelcalcetide for treating secondary hyperparathyroidism in people with chronic kidney disease, receiving haemodialysis

People with chronic kidney disease experience a progressive worsening of their kidney function over time and can develop complications due to this loss of function. A common complication is secondary hyperparathyroidism. Secondary hyperparathyroidism can develop in the early stages of chronic kidney disease, but nearly all people with end-stage disease and who receive dialysis treatment for the disease (which removes waste and excessive fluids from the blood, due to the kidney not being able to do this) will have it. Hyperparathyroidism is characterised by high levels of phosphate and low levels of calcium in the blood. Loss of kidney function causes secondary hyperparathyroidism by reducing how much phosphate is excreted from the body, which then results in the parathyroid gland producing more parathyroid hormone to stimulate the kidneys to excrete more phosphate. Eventually, the kidneys are unable to do this and phosphate levels build up. This process also results in the body having difficulty in converting vitamin D into calcium, resulting in low calcium levels, which further stimulates parathyroid gland to release parathyroid hormones. Eventually, the gland enlarges and over-produces the parathyroid hormone, resulting in secondary hyperparathyroidism. Secondary hyperparathyroidism can then cause further problems for some people with chronic kidney disease, including bone and cardiovascular diseases.

Treatment of secondary hyperparathyroidism aims to regulate levels of phosphate, parathyroid hormone and calcium. At present, recommended treatments include changes to patients’ diets, phosphate binders to control phosphate levels, vitamin D analogues, changes to dialysis treatment and sometimes removal of the parathyroid glands. The drug cinacalcet is used to treat secondary hyperparathyroidism that is resistant to treatment, but only under particular circumstances. Etelcalcetide is a new treatment for secondary hyperparathyroidism in chronic kidney disease, which is administered intravenously (through a vein) and which works by reducing the production and secretion of the parathyroid hormone.

SHTAC is assessing the clinical and cost-effectiveness evidence submitted by the company to NICE for etelcalcetide as a treatment for secondary hyperparathyroidism in people with chronic kidney disease, receiving haemodialysis. It is expected that NICE will issue guidance on the use of etelcalcetide as a treatment for secondary hyperparathyroidism in June 2017.

For more information about SHTAC’s previous research into genito-urinary system diseases please visit our Research page

 

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×