Efficacy and Safety of Alfacalcidol Compared to Calcitriol for Treatment of Secondary Hyperparathyroidism

This study has been completed.
Information provided by:
Mahidol University
ClinicalTrials.gov Identifier:
First received: May 1, 2010
Last updated: NA
Last verified: May 2010
History: No changes posted
This study was performed to determine whether calcitriol provides a therapeutic advantage to alfacalcidol for treatment of secondary hyperparathyroidism in ESRD patients.

Condition Intervention Phase
Secondary Hyperparathyroidism
End Stage Renal Disease
Drug: alfacalcidol and calcitriol
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Crossover Assignment
Masking: Single Blind (Investigator)
Primary Purpose: Treatment
Official Title: A Randomized Trial Comparing Pulse Calcitriol and Alfacalcidol for the Treatment of Secondary Hyperparathyroidism in Hemodialysis Patients

Resource links provided by NLM:

Further study details as provided by Mahidol University:

Primary Outcome Measures:
  • Reduction of intact parathyroid hormone levels [ Time Frame: 48 weeks ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • hypercalcemia and hyperphosphatemia [ Time Frame: 48 weeks ] [ Designated as safety issue: Yes ]
    proportion of the patients who achieved a target PTH, changes in plasma calcium and phosphorus, the proportion of the patients who had hypercalcemia (plasma corrected calcium > 10.8 mg/dl), hyperphosphatemia (plasma phosphorus > 6.0 mg/dl) and calcium-phosphorus products > 55 mg2/dl2 between groups.

Enrollment: 32
Study Start Date: August 2008
Study Completion Date: August 2009
Primary Completion Date: August 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: calcitriol
The subjects were randomized to receive calcitriol in a dose-escalating fashion for up to 24 weeks.
Drug: alfacalcidol and calcitriol
The initial dose of alfacalcidol was twice that of calcitriol.Both were adjusted to control intact PTH within the ranges of 150-300 pg/ml.
Experimental: alfacalcidol Drug: alfacalcidol and calcitriol
The initial dose of alfacalcidol was twice that of calcitriol.Both were adjusted to control intact PTH within the ranges of 150-300 pg/ml.

Detailed Description:
Secondary hyperparathyroidism has a significant impact on morbidity and mortality in advanced chronic kidney disease (CKD).Both nonselective and selective vitamin D receptor activators (VDRAs) are demonstrated in many studies for their efficacy on suppression of PTH. Most of them are quite expensive and unavailable in many countries. Calcitriol and alfacalcidol are less expensive and worldwidely distributed. There is only one short-term study which directly compares these two drugs. This study demonstrates that calcitriol is superior to alfacalcidol. However, alfacalcidol is a prohormone of calcitriol. It has to be converted by 25-hydroxylase at the liver to generate 1,25-dihydroxyvitamin D3 to act on target cells. Many pharmacokinetics studies demonstrate that alfacalcidol has lower AUC compared to calcitriol if they are administered in the same dose. Therefore, the authors hypothesize that alfacalcidol may be equivalently efficacious as calcitriol if its dose is adjusted according to the pharmacokinetics studies.

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Chronic hemodialysis patients who underwent scheduled hemodialysis for at least 3 months with secondary hyperparathyroidism (intact PTH levels > 300 pg/mL)

Exclusion Criteria:

  • (1) age < 18 years (2) hypersensitivity to calcitriol or alfacalcidol (3) inadequate dialysis [defined as single-pooled Kt/V (sp-Kt/V) <1.2 and <2.0 for thrice a week and twice a week hemodialysis] (4) corrected serum calcium >10.2 mg/dL or serum phosphate >6 mg/dL after adjusting dialysate calcium and phosphate binders (5) diameter of parathyroid gland >10 mm (6) pregnancy or lactation (7) liver cirrhosis (8) active kidney transplantation (9) previous parathyroidectomy (10) malignancy or chronic infection/inflammation.
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Please refer to this study by its ClinicalTrials.gov identifier: NCT01115543

Siriraj Medical School
Bangkok-noi, Bangkok, Thailand, 10700
Sponsors and Collaborators
Mahidol University
  More Information

Responsible Party: Dr. Kraiwiporn Kiattisunthorn, Siriraj Medical School, Mahidol University
ClinicalTrials.gov Identifier: NCT01115543     History of Changes
Other Study ID Numbers: 358/2551 
Study First Received: May 1, 2010
Last Updated: May 1, 2010
Health Authority: Thailand: Ethical Committee

Additional relevant MeSH terms:
Hyperparathyroidism, Secondary
Kidney Failure, Chronic
Neoplasm Metastasis
Renal Insufficiency, Chronic
Endocrine System Diseases
Kidney Diseases
Neoplastic Processes
Parathyroid Diseases
Pathologic Processes
Renal Insufficiency
Urologic Diseases
Bone Density Conservation Agents
Calcium Channel Agonists
Growth Substances
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Physiological Effects of Drugs
Vasoconstrictor Agents

ClinicalTrials.gov processed this record on May 30, 2016