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. 2025 Nov;104(5):310-317.
doi: 10.5414/CN111695.

The effects of switching from etelcalcetide to upacicalcet in hemodialysis patients with secondary hyperparathyroidism

Eiichi Sato, Miyako Urata, Shohei Sato, Takao Ono, Manaka Degawa, Hongmei Lu, Mayumi Nomura, Daisuke Matsumura, Noriaki Moriyama, Mayuko Amaha, Tsukasa Nakamura

The effects of switching from etelcalcetide to upacicalcet in hemodialysis patients with secondary hyperparathyroidism

Eiichi Sato et al. Clin Nephrol. 2025 Nov.

Abstract

Aims: No English-language research papers have reported on the clinical use of upacicalcet, a novel intravenous calcimimetic agent for the treatment of secondary hyperparathyroidism (SHPT) in hemodialysis patients. Therefore, this study aimed to investigate the outcomes of switching from etelcalcetide to upacicalcet.

Materials and methods: The subjects included 37 hemodialysis patients with SHPT treated with etelcalcetide before switching to upacicalcet. This study was a single-center retrospective study conducted in Japan. Serum levels of corrected calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH), and the dose of maxacalcitol were assessed at 3 and 6 months after switching to upacicalcet.

Results: As a result of the switch from etelcalcetide to upacicalcet, the serum corrected Ca level remained unchanged, from 8.9 ± 0.6 to 9.1 ± 0.7 mg/dL (p = 0.104) at 3 months and to 9.0 ± 0.6 mg/dL (p = 0.197) at 6 months. Meanwhile, the serum P level decreased from 6.3 ± 1.5 to 5.8 ± 1.5 mg/dL (p = 0.069) at 3 months and to 5.9 ± 1.9 mg/dL (p = 0.039) at 6 months. The iPTH level increased slightly, from 153.8 ± 100.3 pg/mL to 176.4 ± 124.6 pg/mL (p = 0.337) at 3 months and to 206.5 ± 168.7 pg/mL (p = 0.017) at 6 months. Multiple regression analysis revealed that the change in iPTH was related to the change in P levels.

Conclusion: These findings suggested that upacicalcet may be a useful option for managing serum P levels in hemodialysis patients with SHPT.

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Conflict of interest statement

This study was conducted with funds provided by Sanwa Kagaku Kenkyusho Co., Ltd., according to the contract; however, this did not have an impact on the conduct or evaluation of this study. In addition, funds were not provided to the study facility or the investigators. Sanwa Kagaku Kenkyusho Co., Ltd., only provided funds for the outsourcing of the operations.

Figures

Figure 1
Figure 1. Time course of serum corrected calcium level (a), serum phosphorus level (b), and serum intact parathyroid hormone level (c). Data are presented as mean ± SD.
Figure 2
Figure 2. Changes in phosphorus level for individual patients from baseline to week 24.
Figure 3
Figure 3. Time course of the dose of maxacalcitol (25 patients). Data are presented as mean ± SD.
See this image and copyright information in PMC

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