Phosphate-Binder Swap Has Benefits
Lanthanum carbonate maintains phosphorus control and lowers daily phosphate-binder dose
Researchers studied 1,751 patients, nearly half of whom had diabetes. Nirupama Vemuri, MD, of the South Florida Nephrology Group in Coral Springs, and her colleagues compared serum phosphorus levels at baseline (when patients were on a phosphate binder) and after 12 and 16 weeks of lanthanum carbonate (Fosrenol).
Through week 16, lanthanum carbonate maintained serum phosphorus at levels similar to those achieved with the previous phosphate binders. The overall proportion of patients on lanthanum carbonate with serum phosphate controlled within the target range recommended by the National Kidney Foundation (NKF) guidelines (3.5-5.5 mg/dL) remained constant through weeks 12 (44.9%) and 16 (41.6%). Findings were presented here at the NKF 2007 Spring Clinical Meetings.
Furthermore, at baseline, patients previously taking sevelamer had a mean 7.64-gram daily dose of the drug. After 12 weeks of receiving lanthanum carbonate, patients had a mean daily dose of 2.78 grams, a 64% reduction. Patients previously taking calcium-based binders had a mean daily dose of 5.4 grams at baseline. At week 12, their mean daily lanthanum carbonate dose was 2.72 grams, a 50% reduction. In addition, after 12 weeks of receiving lanthanum carbonate, patients previously taking sevelamer had a mean decrease of 3.4 tablets per day and those previously on calcium-based binders had a mean decrease of 2.2 tablets per day.
At baseline, 52% of physicians agreed or strongly agreed that, based on clinical observations, they were satisfied overall with previous phosphate-binder treatments; after switching to lanthanum carbonate for 12 weeks, the proportion of physicians satisfied with therapy rose to 84%.
Patients had initially received a lanthanum carbonate at a dosage of 1,500 mg/day divided among meals, with weekly dose adjustments in 750 mg/day increments as needed to achieve serum phosphorus levels recommended by NKF guidelines.