The EC approved Parsabiv based on three Phase 3 studies, all of which met their primary endpoints, including two pooled placebo-controlled trials in more than 1,000 patients, and a head-to-head study with cinacalcet. Additionally, etelcalcetide was superior to cinacalcet for the secondary endpoints of proportion of patients achieving greater than 30 percent and greater than 50 percent reduction in mean parathyroid hormone (PTH) during the Efficacy Assessment Phase (EAP) compared with baseline.
"Treatment adherence can be a challenge with any oral medicine," said Sean E. Harper, M.D., executive vice president of Research and Development at Amgen. "If poorly controlled, sHPT may progress and can have significant clinical consequences. With Parsabiv, we can put the delivery of the therapy in the hands of the healthcare provider and help ensure that these patients receive this important treatment as part of their dialysis session three times a week."
Approval from the EC grants a centralized marketing authorization with unified labeling in the 28 countries that are members of the EU. Norway, Iceland and Liechtenstein, as members of the European Economic Area (EEA), will take corresponding decisions on the basis of the decision of the EC.
About Secondary Hyperparathyroidism (sHPT)
sHPT is a chronic and serious condition which affects many of the approximately two million people throughout the world who are receiving dialysis.1,2 In Europe, the prevalence of sHPT within dialysis populations ranges from 30 to 49 percent.3 Approximately 88 percent of dialysis patients and 79 percent of patients on hemodialysis will develop sHPT.4 sHPT refers to the excessive secretion of parathyroid hormone (PTH) by the parathyroid glands in response to decreased renal function and impaired mineral metabolism.1 The elevated levels of PTH can lead to an increase in the release of calcium and phosphorus from the bones.5 sHPT is often initially silent and asymptomatic.1 As a result, sHPT is frequently underdiagnosed and undertreated.1,6
About Parsabiv™ (etelcalcetide)
Parsabiv is a novel calcimimetic agent indicated for the treatment of secondary hyperparathyroidism (sHPT) in adult patients with chronic kidney disease (CKD) on hemodialysis therapy. A calcimimetic is a drug that mimics the action of calcium by activating the calcium-sensing receptors on the parathyroid gland. Parsabiv binds to and activates the calcium-sensing receptor on the parathyroid gland, thereby decreasing PTH levels.
Important Safety Information
Contraindications: Hypersensitivity to the active substance or to any of the excipients. Parsabiv should not be initiated if corrected serum calcium is less than the lower limit of the normal range.
Special Warnings and Precautions:
Hypocalcaemia: Since etelcalcetide lowers serum calcium, patients should be advised to seek medical attention if they experience symptoms of hypocalcaemia and should be monitored for the occurrence of hypocalcaemia. Serum calcium levels should be measured prior to initiating treatment, within 1 week of initiation or dose adjustment of Parsabiv and every 4 weeks during treatment. Potential manifestations of hypocalcaemia include paraesthesias, myalgias, muscle spasm and seizures. Decreases in serum calcium can prolong the QT interval, potentially resulting in ventricular arrhythmia. The threshold for seizures may be lowered by significant reductions in serum calcium levels.
Worsening heart failure: Decreased myocardial performance, hypotension, and congestive heart failure may be associated with significant reductions in serum calcium levels.
Co-administration with other medicinal products
Administer Parsabiv with caution in patients receiving any other medicinal products known to lower serum calcium. Patients receiving Parsabiv should not be given cinacalcet. Concurrent administration may result in severe hypocalcaemia.
Interactions: No interaction studies have been performed. There is no known risk of pharmacokinetic interaction with Parsabiv.
Fertility, Pregnancy and Lactation: There are no or limited amount of data from the use of Parsabiv in pregnant women. Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity. As a precautionary measure, it is preferable to avoid the use of Parsabiv during pregnancy. A risk to breastfed newborns/infants cannot be excluded. A decision must be made whether to discontinue breast-feeding or discontinue/abstain from Parsabiv therapy taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman. No data are available on the effect of etelcalcetide on human fertility. Animal studies do not indicate direct or indirect harmful effects with respect to fertility.
Undesirable Effects: The following common (≥10%) adverse reactions have been reported in pivotal, controlled clinical studies: decreases in serum calcium, diarrhoea, nausea, vomiting, and muscle spasms.
Pharmaceutical Precautions: Store in a refrigerator (2 degrees C – 8 degrees C). Once removed from the refrigerator, Parsabiv must be used within 7 days if stored in the original carton.
About Mimpara® (cinacalcet)
Mimpara® (cinacalcet) is the first oral calcimimetic agent approved by the European Medicines Agency for the treatment of sHPT in patients with CKD on dialysis. The therapy is also approved in the EU for the treatment of hypercalcemia in patients with parathyroid carcinoma and hypercalcemia in adult patients with primary HPT for whom parathyroidectomy would be indicated on the basis of serum calcium levels (as defined by relevant treatment guidelines), but in whom parathyroidectomy is not clinically appropriate or is contraindicated. Mimpara binds to the calcium-sensing receptor, resulting in a drop in PTH levels by inhibiting PTH synthesis and secretion. In addition, the reductions in PTH lower serum calcium and phosphorus levels.
Important Safety Information
Contraindications: Hypersensitivity to the active substance or to any of the excipients
Special Warnings and Precautions:
Mimpara treatment should not be initiated in patients with a serum calcium below the lower limit of the normal range. Life threatening events and fatal outcomes associated with hypocalcaemia have been reported in adult and paediatric patients treated with Mimpara. Manifestations of hypocalcaemia may include paraesthesias, myalgias, cramping, tetany and convulsions. Decreases in serum calcium can also prolong the QT interval, potentially resulting in ventricular arrhythmia secondary to hypocalcaemia. The threshold for seizures is lowered by significant reductions in serum calcium levels. Patients should be monitored carefully for the occurrence of hypocalcaemia. Serum calcium should be measured within 1 week after initiation or dose adjustment of Mimpara. Once the maintenance dose has been established, serum calcium should be measured approximately monthly.
Hypotension and/or worsening heart failure: In post-marketing safety surveillance, isolated, idiosyncratic cases of hypotension and/or worsening heart failure have been reported in patients with impaired cardiac function, in which a causal relationship to cinacalcet could not be completely excluded and may be mediated by reductions in serum calcium levels.
Due to the potential for 2 to 4 fold higher plasma levels of cinacalcet in patients with moderate to severe hepatic impairment, Mimpara should be used with caution in these patients and treatment should be closely monitored
In the treatment of secondary hyperparathyroidism the most commonly reported adverse reactions in clinical trials were nausea and vomiting.
To see the full Mimpara Safety Information, visit http://www.ema.europa.eu
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1 Tomasello S. Secondary Hyperparathyroidism and Chronic Kidney Disease. Diabetes Spectrum. 2008 Jan;21(1)19-25.
2 Liyanage T, Ninomiya T, Jha V, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet. 2015; 385: 1975–82.
3 Hedgeman E, Lipworth L, Lowe K, et al. International Burden of Chronic Kidney Disease and Secondary Hyperparathyroidism: A Systematic Review of the Literature and Available Data. Int J Neph. 2015;2015: 184321
4 Data on File, Amgen; 2016.
5 National Institutes of Health. MedlinePlus: Hyperparathyroidism. Available at: www.nlm.nih.gov/medlineplus/ency/article/001215.htm. Accessed November 8, 2016
6 National Kidney Foundation. Parathyroid Hormone and Secondary Hyperparathyroidism in Chronic Kidney Disease. Available at: https://www.kidney.org/sites/default/files/02-10-4899_GB_SHPT-PTH_v8.pdf. Accessed November 8, 2016.
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