Switch to an Iron-Based Binder Found to Improve Phosphorus Lowering

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Converting hemodialysis patient to sucroferric oxyhydroxide from a previous binder increased the proportion of patients achieving target serum phosphorus levels.
Converting hemodialysis patient to sucroferric oxyhydroxide from a previous binder increased the proportion of patients achieving target serum phosphorus levels.

A study of electronic records from routine clinical practice showed that switching hemodialysis patients to the iron-based phosphate binder sucroferric oxyhydroxide increased the proportion of patients who achieve serum phosphate levels of 5.5 mg/dL or below. The switch also was associated with a reduction in average daily pill burden.

Of 1029 patients already taking a phosphate binder, just 13.9% had their mean serum phosphorus levels at the target range at baseline. After switching to sucroferric oxyhydroxide (Velphoro), 26.1% reached the target range over 3 months, Daniel W. Coyne, MD, of Washington University School of Medicine in St. Louis, and colleagues reported online ahead of print in Clinical Nephrology. The average daily pill count was decreased from 9.6 to 3.8. Investigators observed the same pattern for 424 patients who continued taking sucroferric oxyhydroxide for another 3 months. The proportion of patients with serum phosphorus in the target range increased from 15.6% to 30.4%. The average daily pill count declined from 9.7 to 4.0. Of patients not included in the 6 month analysis, 172 had started receiving another binder along with sucroferric oxyhydroxide and 199 were switched completely to other binders.

“Velphoro was started in patients with poor phosphorus control on their present binder,” Dr Coyne told Renal & Urology News. “Regardless of previous binder, conversion to Velphoro led to a small but sustained improvement in phosphorus at 1 to 3 and 4 to 6 months, while binder pill burden was more than halved. The conversion also was associated with slight reductions in epoetin dose and intravenous iron use.”

Gastrointestinal absorption of iron from sucroferric oxydroxide appears to be minimal, according to previous research.

“Patients converted to Velphoro had a sustained improvement in serum phosphorus, but most still had values above 5.5 mg per day,” Dr Coyne added. “Few patients had their Velphoro dose increased over the 6 month period, suggesting regular dose titration could improve outcomes.”

The investigators noted a slight decline in equilibrated normalized protein catabolic rate by 0.02 g/kg/day from baseline, despite dialysis adequacy.

Several investigators disclosed that they are employees of Fresenius Medical Care North America, which produces Velphoro.

Reference

Coyne DW, Ficociello LH, Parameswaran V, Anderson L, Vemula S, Ofsthun NJ, Mullon C, Maddux FW, Kossmann RJ, and Sprague SM. Real-world effectiveness of sucroferric oxyhydroxide in patients on chronic hemodialysis: A retrospective analysis of pharmacy data. Clin Nephrol, doi: 10.5414/CN109021

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