How has EVOLVE evolved. Single study review
https://doi.org/10.28996/1680-4422-2017-3-342-358
Abstract
The review scrutinize the publication of primary and secondary results of one of the largest randomized trial in nephrology EVOLVE, which assessed the effects of treatment with cinacalcet or placebo in 3883 patients with secondary hyperparathyroidism on cardiovascular outcomes with follow-up up period of 5.6 years. Despite neutral results in primary end-point, the series of secondary analyses revealed the possibilities to suggest the ways for improving the efficiency of antihyperparathyroid strategies, which nevertheless require special trails. The improvements in cardiovascular outcomes were observed: (1) while limiting the follow-up period to six months after treatment termination; (2) in patient older than 65 years; (3) while the FGF23 level decreased by >30% during the treatment; (4) while accounting only for "non-atherosclerotic" cardiovascular events; (5) in patients with baseline PTH level below 900 pg/ml; (6) in patients with baseline dialysis shorter then 2 years. The two latter factors indicate a lower probability of the development of autonomous adenomas. The results concerning hypertension and fractures are discussed as well as the dependence of cinalalcet effects from calcium dialysate concentrations and the vitamin D levels or VDRA therapy. The interpretation of EVOLVE results are further complicated due to the difference in protocol defined goals in PTH level (below 300 pg/ml) and target range of PTH, defined in current KDIGO guidelines (both 2009 and 2017 update). The searching of optimal practice of calcimimetics use are being actualized by recent approvement of intravenous drug in the class - etelcalcetide ensuring 100% compliance by route of administration; perhaps, it is the reason for its higher efficiency in head-to-head comparison as well as for higher incidence of side effects frequency - both approximately by 10
About the Author
A. Yu. Zemchenkov
I.I. Mechnikov North-Western State medical university; I.P. Pavlov First St.-Petersburg State medical university
Russian Federation
Russian Federation
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Zemchenkov A.Yu. How has EVOLVE evolved. Single study review. Nephrology and Dialysis. 2017;19(3):342-358. (In Russ.) https://doi.org/10.28996/1680-4422-2017-3-342-358
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