DEVELOPMENT OF EVOCALCET AS CALCIMIMETIC

Evocalcet is a novel oral calcimimetic developed to overcome limitations of cinacalcet, such as gastrointestinal intolerance and CYP2D6-mediated drug interactions, while maintaining efficacy in suppressing parathyroid hormone (PTH) levels in secondary hyperparathyroidism (SHPT). In a 30-week randomized Phase III trial in Japanese hemodialysis patients, gastrointestinal adverse events occurred in 18.6% with evocalcet versus 32.8% with cinacalcet (difference −14.2% [95% CI −20.9, −7.5]), while PTH suppression met non-inferiority criteria (difference −4.0% [95% CI −11.4, 3.5]). Evocalcet demonstrated favorable pharmacokinetics with higher bioavailability (62–84%) and once-daily oral dosing. Limitations include restricted global availability and lack of long-term cardiovascular outcome data. This review summarizes the development, pharmacology, clinical evidence, and future directions of evocalcet.