Abstract: Etelcalcetide is a new calcimimetic indicated for the treatment of secondary
hyperparathyroidism (SHPT) in dialysis patients. Etelcalcetide ecacy in SHPT has been ascertained
only in randomized controlled trials. This multicenter study was carried out in “real world” setting that
is dierent from randomized controlled trials (RCTs) to (1) evaluate the eectiveness of etelcalcetide in
SHPT, (2) to assess calcium, phosphorus, alkaline phosphatase changes, (3) to register gastrointestinal
side eects. Data were collected from twenty-three dialysis units with n = 1190 patients on the
charge. From this cohort, n = 168 (14%) patients were on treatment with etelcalcetide, and they were
evaluated for statistics. A median weekly dose of etelcalcetide was 15 mg (7.5–45 mg). Patients were
either naïve (33%) or switched from cinacalcet to obtain better control of SHPT with reduced side
eects or pills burden. Serum parathyroid hormone (PTH) declined over time from a median value
of 636 pg/mL to 357 pg/mL. The median time for responders (intact PTH (iPTH) range: two to nine
times the upper normal limit) was 53 days; the percentage of responders increased (from baseline
27% to 63%) being similar in switched-patients and naïve-patients. Few patients had symptomatic
hypocalcemia requiring etelcalcetide withdrawal (four cases (3%) at 30-day control, two cases (2%)
at 60-day, one case (1%) at 90-day control). Side eects with etelcalcetide were lower (3–4%) than
that registered during cinacalcet treatment (53%). Etelcalcetide is a new therapeutic option for SHPT
with low side eects and pills burden. Etelcalcetide may improve adherence to therapy, avoiding
unremitting SHP. It remains to be assessed whether etelcalcetide may reduce parathyroidectomy,
vascular calcification, or mortality. Being etelcalcetide very potent in suppressing PTH levels, even in
severe SHPT, future studies should evaluate the potential risk of more adynamic bone disease during
long-term therapy