In the past, when I would think about treating secondary hyperparathyroidism, it was a lot like juggling. Treatment for me could include giving my patients phosphate binders and vitamin D. Sometimes, the phosphate binders would cause my patient’s calcium levels to go up. And if you give vitamin D, that could raise the calcium and phosphorus; so in those instances it would feel like you’re kind of chasing your tail.

Parsabiv^® has had a huge impact on what we do at our practice in regards to the way we treat sHPT. For myself, and most of my colleagues, we routinely write Parsabiv^® for appropriate patients. And I see that trend continuing because we have seen good results when managing sHPT with Parsabiv^®.

I would say, if you have a patient who you believe could benefit from a treatment like Parsabiv^® (etelcalcetide), you have to advocate for them. And I do that every day. Ultimately, we’ve got to do what we feel is right for our patients. I couldn’t sleep at night unless I felt “today, I did all I can for my patients.” That’s my responsibility—and I think most nephrologists feel the same way.

Individual results may vary

I was cautiously optimistic that Parsabiv^® (etelcalcetide) would help, because now we are in control of administering the medication to our patients. Parsabiv^® further justified my belief in calcimimetics.

I have this one patient with sHPT—she had a wake-up call when I recommended she meet with a surgeon. Up until then, she wasn’t very active in her care. As soon as Parsabiv^® (etelcalcetide) came out, she was the first patient in her dialysis unit to receive it. We initiated her on 5 milligrams, 3 times a week at the end of hemodialysis, and we titrated her dose based on her labs. We didn’t even need to titrate to the maximum dose and in a few months her PTH was in range. After a year of treatment on Parsabiv^®, her PTH is still in range without me having to significantly change her dose. Her secondary hyperparathyroidism is well managed and she is more active in her care.

It feels great to share good news with patients, because frankly these are people who may not be used to hearing a lot of good news. That’s really inspiring to me, and now I am working very closely with my care team to monitor and identify other patients who may be appropriate for Parsabiv^® (etelcalcetide).

First and foremost, I will write Parsabiv^® when I feel it’s important for us to control administration. We initiate Parsabiv^® (etelcalcetide) for appropriate patients in order to manage their sHPT. We start them out at the approved dose, which is 5 mg 3 times a week, at the end of hemodialysis. It’s important to ensure that a patient’s serum calcium is at or above the lower limit of normal before initiating Parsabiv^®. Following initiation, check the patient’s calcium levels after 1 week, then every 4 weeks after that. Also, you need to check the patient’s PTH levels after 4 weeks, then continue to check PTH based on whatever your practice does. Of course, all dosing and monitoring information can be found in the package insert.

Once you’ve decided to prescribe Parsabiv^®, we need to work with our dialysis organization to make sure we get that patient on Parsabiv^®.

I cannot stress enough the peace of mind I have knowing that I control administration with Parsabiv^®. I’ve been in dialysis over 35 years and I’ve seen what these patients go through. It’s not an easy life. That’s why I fight for Parsabiv^®—I do it for my patients because I care about them, and I’ve seen the difference Parsabiv^® can make. And that’s what matters most to me. It works.

We work together to establish great communication, which relates to everyone knowing what our treatment goals are for sHPT—aligning on what labs we want to achieve and how to get there. Also knowing what triggers exist when it’s time to start a new therapy.