Comparison On Efficacy And Safety Of Treatments For Secondary Hyperparathyroidism In Dialysis Patients:A Bayesian Network Analysis

Objective:a Bayesian network analysis was conducted to evaluate the relative efficacy and safety of calcitriol,paricalcitol,cinacalcet,etelcalcetide,and evocalcet for secondary hyperparathyroidism(SHPT)in dialysis patients to provide scientific basis for clinical decisions.Methods:We searched for published randomized controlled studies in CBM,CNKI,VIP,Wangfang database,Pubmed,Cochrane library and EMBASE database.Studies included calcitriol,paricalcitol,cinacalcet,etelcalcetide,and evocalcet.The primary outcome was the treatment effect on the proportion of?30%decrease in serum parathyroid hormone(PTH).Secondary outcomes included the level of serum calcium and serum phosphorus as well as the occurrence of nausea vomiting and diarrhea.The traditional meta-analysis was performed using Statal5 software and a network meta-analysis was performed using GeMTC software.Results:Twenty randomized clinical trials,including 11382 patients were included in this systemic review.calcitriol,paricalcitol and etelcalcetide showed no evident difference in affecting the change of parathyroid hormone(PTH),which were superior to cinacalcet and evocalcet.There were no significant difference between in cinacalcet and evocalcet.Compared with etelcalcetide and cinacalcet,calcitriol and paricalcitol had higher levels of serum calcium and phosphorus.Calcitriol and paricalcitol had no significant effect on serum calcium and serum phosphorus;Cinacalcet and etelcalcetide had no significant effect on serum calcium and serum phosphorus;Since the study on evocalcet did not give the values of serum calcium and serum phosphorus,it was not included in network meta-analysis.There was no significant difference in the incidence of nausea,vomiting,and diarrhea among cinacalcet,etelcalcetide,and evocalcet.Conclusion:1.Calcitriol,paricalcitol and etelcalcetide are effective in reducing PTH levels.Calcitriol and paricalcitol can increase serum calcium and serum phosphorus to increase cardiovascular events,So etelcalcetide perhaps is the best treatment for the SHPT and we should should monitor serum calcium to avoid hypocalcemia.2.There is no significant difference in the incidence of gastrointestinal tracts of cinacalcet,etelcalcetide,and evocalcet.