Objective To evaluate the efficacy and adverse reactions of etelcalcetide in the treatment of secondary hyperparathyroidism in hemodialysis patients. Methods Randomized controlled trials or cohort studies on Etelcalcetide in the treatment of secondary hyperparathyroidism (SHPT) in dialysis patients published before May 2024 were searched in CNKI, Wanfang Database, PubMed, Embase and Cochrane library. Meta-analysis was performed by the software RevMan 5.0. Results A total of 14 articles were included, including 15 experiments, with a total sample size of 9628 cases. Meta-analysis showed that Etelcalcetide was more effective in reducing PTH level by 30% than the control group (Blank control group: RR=8.440, 95% CI: 6.515～10.935, P＜0.001; Cinacalcet group: RR=1.131, 95% CI:1.040～1.229, P= 0.004; Vitamin D receptor agonist group: RR=4.272, 95% CI: 2.259～8.081, P< 0.001), improving serum phosphate compliance rate (RR=1.122, 95% CI: 1.049～1.205, P=0.001) and decreasing the level of serum fibroblast growth factor (FGF-23) (treatment time < 1 year: MD=-0.563, 95% CI: -0.713～-0.413, P<0.001 ; treatment duration ≥1 year: MD=-2.108, 95% CI: -2.405～-1.812, P < 0.001), while no statistical differences in the rate of serum calcium compliance (RR=0.910, 95% CI: 0.778～1.064, P=0.240) and drug persistence (RR=1.439, 95% CI: 0.903～2.292, P=0.120). In terms of adverse events, the incidence of symptomatic hypocalcemia was higher in Etelcalcetide group than in control group (RR=2.890，95% CI：1.915～4.361, P＜0.001), and the incidence of nausea in Etelcalcetide group was higher than that in blank control group (RR=1.747, 95% CI: 1.150～2.652, P=0.009), which was lower than that in oral medication group (RR=0.769, 95% CI: 0.611～0.969, P=0.030), while no significant difference in the incidence of vomiting. Conclusion Etelcalcetide, a new generation of intravenous calcimimetic agent, has more advantages in reducing PTH level, improving hyperphosphatemia and reducing FGF-23 level, but it increased the incidence of hypocalcemia.
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