A comparative analysis of the efficacy and safety of paricalcitol versus other vitamin D receptor activators in patients undergoing hemodialysis: A systematic review and meta-analysis of 15 randomized controlled trials
Paricalcitol, a new vitamin D receptor activator (VDRA), is reported to be more effective than other VDRAs in reducing calcium and phosphorus levels in patients undergoing hemodialysis. However, the efficacy and safety of paricalcitol remain controversial. This analysis compares paricalcitol with ot...
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| description | Paricalcitol, a new vitamin D receptor activator (VDRA), is reported to be more effective than other VDRAs in reducing calcium and phosphorus levels in patients undergoing hemodialysis. However, the efficacy and safety of paricalcitol remain controversial. This analysis compares paricalcitol with other VDRAs in patients undergoing hemodialysis. We searched the Cochrane Library, PubMed, EMBASE, Web of Science, and CNKI up to April 22, 2019. Standardized mean difference (SMD), risk ratio (RR) and 95% confidence interval (CI) values were estimated to compare the outcomes of the groups. Two reviewers extracted data and assessed trial quality independently. All statistical analyses were performed using the standard statistical procedures of RevMan 5.2 and Stata 12.0. Fifteen studies (N = 110,544) were included in this meta-analysis. Of these studies, 11 were randomized controlled trials (RCTs) and 4 were non-randomized studies of interventions (NRSIs). Patients receiving paricalcitol experienced better overall survival (OS) than patients receiving other VDRAs, with a pooled hazard ratio of 0.86 (95% CI 0.80-0.91; P < 0.00001). Intact parathyroid hormone (iPTH) levels were significantly reduced in the paricalcitol group compared to the group receiving other VDRAs, with a pooled SMD of -0.53 (95% CI -0.89- -0.16; P = 0.004). There was a significant increase in serum calcium levels from baseline in the paricalcitol group compared to the other VDRAs group when limiting the analysis to RCTs, with a pooled SMD of 2.14 (95% CI 0.90-3.38; P = 0.0007). Changes in serum calcium levels were significantly lower in the paricalcitol group when the analysis was limited to NRSIs, with a pooled SMD of -0.85 (95% CI -1.34--0.35; P = 0.0008). The NSRI analysis also showed a significant reduction in serum phosphorus levels in the paricalcitol group, with a pooled SMD of -0.57 (95% CI -1.00--0.13; P = 0.01). No significant differences were observed in the incidence of hypercalcemia, hyperphosphatemia, or adverse events. Generally, paricalcitol seems superior to other VDRAs in reducing mortality and iPTH levels in patients undergoing hemodialysis. However, the comparative effectiveness of paricalcitol in reducing serum calcium and phosphorus levels needs further exploration. No significant difference was found in the rate of adverse events. |
| doi_str_mv | 10.1371/journal.pone.0233705 |
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However, the efficacy and safety of paricalcitol remain controversial. This analysis compares paricalcitol with other VDRAs in patients undergoing hemodialysis. We searched the Cochrane Library, PubMed, EMBASE, Web of Science, and CNKI up to April 22, 2019. Standardized mean difference (SMD), risk ratio (RR) and 95% confidence interval (CI) values were estimated to compare the outcomes of the groups. Two reviewers extracted data and assessed trial quality independently. All statistical analyses were performed using the standard statistical procedures of RevMan 5.2 and Stata 12.0. Fifteen studies (N = 110,544) were included in this meta-analysis. Of these studies, 11 were randomized controlled trials (RCTs) and 4 were non-randomized studies of interventions (NRSIs). Patients receiving paricalcitol experienced better overall survival (OS) than patients receiving other VDRAs, with a pooled hazard ratio of 0.86 (95% CI 0.80-0.91; P < 0.00001). Intact parathyroid hormone (iPTH) levels were significantly reduced in the paricalcitol group compared to the group receiving other VDRAs, with a pooled SMD of -0.53 (95% CI -0.89- -0.16; P = 0.004). There was a significant increase in serum calcium levels from baseline in the paricalcitol group compared to the other VDRAs group when limiting the analysis to RCTs, with a pooled SMD of 2.14 (95% CI 0.90-3.38; P = 0.0007). Changes in serum calcium levels were significantly lower in the paricalcitol group when the analysis was limited to NRSIs, with a pooled SMD of -0.85 (95% CI -1.34--0.35; P = 0.0008). The NSRI analysis also showed a significant reduction in serum phosphorus levels in the paricalcitol group, with a pooled SMD of -0.57 (95% CI -1.00--0.13; P = 0.01). No significant differences were observed in the incidence of hypercalcemia, hyperphosphatemia, or adverse events. Generally, paricalcitol seems superior to other VDRAs in reducing mortality and iPTH levels in patients undergoing hemodialysis. However, the comparative effectiveness of paricalcitol in reducing serum calcium and phosphorus levels needs further exploration. No significant difference was found in the rate of adverse events.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0233705</identifier><identifier>PMID: 32470067</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Bias ; Biology and Life Sciences ; Calciferol ; Calcium ; Calcium (blood) ; Cardiovascular disease ; Clinical trials ; Comparative analysis ; Confidence intervals ; Drug therapy ; Hemodialysis ; Hemodialysis patients ; Hospitals ; Hypercalcemia ; Hyperphosphatemia ; Kidney diseases ; Medical ethics ; Medical research ; Medicine and Health Sciences ; Meta-analysis ; Metabolism ; Metabolites ; Mortality ; Parathyroid ; Parathyroid hormone ; Paricalcitol ; Phosphorus ; Physical sciences ; Quality ; Quality assessment ; Randomization ; Receptors ; Research and Analysis Methods ; Safety ; Science Policy ; Sensitivity analysis ; Statistical analysis ; Statistical analysis of data ; Statistics ; Studies ; Systematic review ; Vitamin D</subject><ispartof>PloS one, 2020-05, Vol.15 (5), p.e0233705-e0233705</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Geng et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Geng et al 2020 Geng et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c622t-b96a8204bc53dda5ac94a22406181a767df096007878ba6a1f824b2ee060b4d03</citedby><cites>FETCH-LOGICAL-c622t-b96a8204bc53dda5ac94a22406181a767df096007878ba6a1f824b2ee060b4d03</cites><orcidid>0000-0001-5575-8394</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7259607/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7259607/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32470067$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Delanaye, Pierre</contributor><creatorcontrib>Geng, Xinghua</creatorcontrib><creatorcontrib>Shi, Ermin</creatorcontrib><creatorcontrib>Wang, Shiwei</creatorcontrib><creatorcontrib>Song, Yuzhi</creatorcontrib><title>A comparative analysis of the efficacy and safety of paricalcitol versus other vitamin D receptor activators in patients undergoing hemodialysis: A systematic review and meta-analysis of 15 randomized controlled trials</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Paricalcitol, a new vitamin D receptor activator (VDRA), is reported to be more effective than other VDRAs in reducing calcium and phosphorus levels in patients undergoing hemodialysis. However, the efficacy and safety of paricalcitol remain controversial. This analysis compares paricalcitol with other VDRAs in patients undergoing hemodialysis. We searched the Cochrane Library, PubMed, EMBASE, Web of Science, and CNKI up to April 22, 2019. Standardized mean difference (SMD), risk ratio (RR) and 95% confidence interval (CI) values were estimated to compare the outcomes of the groups. Two reviewers extracted data and assessed trial quality independently. All statistical analyses were performed using the standard statistical procedures of RevMan 5.2 and Stata 12.0. Fifteen studies (N = 110,544) were included in this meta-analysis. Of these studies, 11 were randomized controlled trials (RCTs) and 4 were non-randomized studies of interventions (NRSIs). Patients receiving paricalcitol experienced better overall survival (OS) than patients receiving other VDRAs, with a pooled hazard ratio of 0.86 (95% CI 0.80-0.91; P < 0.00001). Intact parathyroid hormone (iPTH) levels were significantly reduced in the paricalcitol group compared to the group receiving other VDRAs, with a pooled SMD of -0.53 (95% CI -0.89- -0.16; P = 0.004). There was a significant increase in serum calcium levels from baseline in the paricalcitol group compared to the other VDRAs group when limiting the analysis to RCTs, with a pooled SMD of 2.14 (95% CI 0.90-3.38; P = 0.0007). Changes in serum calcium levels were significantly lower in the paricalcitol group when the analysis was limited to NRSIs, with a pooled SMD of -0.85 (95% CI -1.34--0.35; P = 0.0008). The NSRI analysis also showed a significant reduction in serum phosphorus levels in the paricalcitol group, with a pooled SMD of -0.57 (95% CI -1.00--0.13; P = 0.01). No significant differences were observed in the incidence of hypercalcemia, hyperphosphatemia, or adverse events. Generally, paricalcitol seems superior to other VDRAs in reducing mortality and iPTH levels in patients undergoing hemodialysis. However, the comparative effectiveness of paricalcitol in reducing serum calcium and phosphorus levels needs further exploration. No significant difference was found in the rate of adverse events.</description><subject>Bias</subject><subject>Biology and Life Sciences</subject><subject>Calciferol</subject><subject>Calcium</subject><subject>Calcium (blood)</subject><subject>Cardiovascular disease</subject><subject>Clinical trials</subject><subject>Comparative analysis</subject><subject>Confidence intervals</subject><subject>Drug therapy</subject><subject>Hemodialysis</subject><subject>Hemodialysis patients</subject><subject>Hospitals</subject><subject>Hypercalcemia</subject><subject>Hyperphosphatemia</subject><subject>Kidney diseases</subject><subject>Medical ethics</subject><subject>Medical research</subject><subject>Medicine and Health Sciences</subject><subject>Meta-analysis</subject><subject>Metabolism</subject><subject>Metabolites</subject><subject>Mortality</subject><subject>Parathyroid</subject><subject>Parathyroid hormone</subject><subject>Paricalcitol</subject><subject>Phosphorus</subject><subject>Physical 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comparative analysis of the efficacy and safety of paricalcitol versus other vitamin D receptor activators in patients undergoing hemodialysis: A systematic review and meta-analysis of 15 randomized controlled trials</title><author>Geng, Xinghua ; Shi, Ermin ; Wang, Shiwei ; Song, Yuzhi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c622t-b96a8204bc53dda5ac94a22406181a767df096007878ba6a1f824b2ee060b4d03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Bias</topic><topic>Biology and Life Sciences</topic><topic>Calciferol</topic><topic>Calcium</topic><topic>Calcium (blood)</topic><topic>Cardiovascular disease</topic><topic>Clinical trials</topic><topic>Comparative analysis</topic><topic>Confidence intervals</topic><topic>Drug therapy</topic><topic>Hemodialysis</topic><topic>Hemodialysis 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in patients undergoing hemodialysis: A systematic review and meta-analysis of 15 randomized controlled trials</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-05-29</date><risdate>2020</risdate><volume>15</volume><issue>5</issue><spage>e0233705</spage><epage>e0233705</epage><pages>e0233705-e0233705</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Paricalcitol, a new vitamin D receptor activator (VDRA), is reported to be more effective than other VDRAs in reducing calcium and phosphorus levels in patients undergoing hemodialysis. However, the efficacy and safety of paricalcitol remain controversial. This analysis compares paricalcitol with other VDRAs in patients undergoing hemodialysis. We searched the Cochrane Library, PubMed, EMBASE, Web of Science, and CNKI up to April 22, 2019. Standardized mean difference (SMD), risk ratio (RR) and 95% confidence interval (CI) values were estimated to compare the outcomes of the groups. Two reviewers extracted data and assessed trial quality independently. All statistical analyses were performed using the standard statistical procedures of RevMan 5.2 and Stata 12.0. Fifteen studies (N = 110,544) were included in this meta-analysis. Of these studies, 11 were randomized controlled trials (RCTs) and 4 were non-randomized studies of interventions (NRSIs). Patients receiving paricalcitol experienced better overall survival (OS) than patients receiving other VDRAs, with a pooled hazard ratio of 0.86 (95% CI 0.80-0.91; P < 0.00001). Intact parathyroid hormone (iPTH) levels were significantly reduced in the paricalcitol group compared to the group receiving other VDRAs, with a pooled SMD of -0.53 (95% CI -0.89- -0.16; P = 0.004). There was a significant increase in serum calcium levels from baseline in the paricalcitol group compared to the other VDRAs group when limiting the analysis to RCTs, with a pooled SMD of 2.14 (95% CI 0.90-3.38; P = 0.0007). Changes in serum calcium levels were significantly lower in the paricalcitol group when the analysis was limited to NRSIs, with a pooled SMD of -0.85 (95% CI -1.34--0.35; P = 0.0008). The NSRI analysis also showed a significant reduction in serum phosphorus levels in the paricalcitol group, with a pooled SMD of -0.57 (95% CI -1.00--0.13; P = 0.01). No significant differences were observed in the incidence of hypercalcemia, hyperphosphatemia, or adverse events. Generally, paricalcitol seems superior to other VDRAs in reducing mortality and iPTH levels in patients undergoing hemodialysis. However, the comparative effectiveness of paricalcitol in reducing serum calcium and phosphorus levels needs further exploration. No significant difference was found in the rate of adverse events.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>32470067</pmid><doi>10.1371/journal.pone.0233705</doi><tpages>e0233705</tpages><orcidid>https://orcid.org/0000-0001-5575-8394</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2020-05, Vol.15 (5), p.e0233705-e0233705 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_gale_infotracacademiconefile_A627434754 |
| source | DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Bias Biology and Life Sciences Calciferol Calcium Calcium (blood) Cardiovascular disease Clinical trials Comparative analysis Confidence intervals Drug therapy Hemodialysis Hemodialysis patients Hospitals Hypercalcemia Hyperphosphatemia Kidney diseases Medical ethics Medical research Medicine and Health Sciences Meta-analysis Metabolism Metabolites Mortality Parathyroid Parathyroid hormone Paricalcitol Phosphorus Physical sciences Quality Quality assessment Randomization Receptors Research and Analysis Methods Safety Science Policy Sensitivity analysis Statistical analysis Statistical analysis of data Statistics Studies Systematic review Vitamin D |
| title | A comparative analysis of the efficacy and safety of paricalcitol versus other vitamin D receptor activators in patients undergoing hemodialysis: A systematic review and meta-analysis of 15 randomized controlled trials |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-06T03%3A33%3A39IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=A%20comparative%20analysis%20of%20the%20efficacy%20and%20safety%20of%20paricalcitol%20versus%20other%20vitamin%20D%20receptor%20activators%20in%E2%80%82patients%20undergoing%20hemodialysis:%20A%20systematic%20review%20and%20meta-analysis%20of%2015%20randomized%20controlled%20trials&rft.jtitle=PloS%20one&rft.au=Geng,%20Xinghua&rft.date=2020-05-29&rft.volume=15&rft.issue=5&rft.spage=e0233705&rft.epage=e0233705&rft.pages=e0233705-e0233705&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0233705&rft_dat=%3Cgale_plos_%3EA627434754%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2407761731&rft_id=info:pmid/32470067&rft_galeid=A627434754&rft_doaj_id=oai_doaj_org_article_473b3e3328bc420886d3fe347572f913&rfr_iscdi=true |