Sucroferric oxyhydroxide aids in effective phosphate management for patients on dialysis
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Adding to data from clinical trials demonstrating the efficacy of sucroferric oxyhydroxide in phosphate management for patients on hemodialysis, researchers from Spain have identified several benefits of the drug in “real-world” settings.
Although “hyperphosphatemia is a practically universal complication” for this patient population, according to Juan F. Navarro-González, PhD, of University Hospital Nuestra Señora de Candelaria, and colleagues, management is difficult because dietary control and dialysis treatments are generally “insufficient” for achieving serum phosphorous targets. Therefore, the researchers wrote, phosphate binders are frequently incorporated into the therapeutic regimen.
“One of the P [phosphate] binders most recently incorporated into clinical practice is sucroferric oxyhydroxide (SO), a complex whose activity depends on the presence of iron in an oxidized state and which has a marked chemical capacity to react with P groups, forming insoluble salts,” they wrote. “ ... Several clinical trials have demonstrated the efficacy and safety of SO in h[e]modialysis (HD) patients, although with very limited real-life data. This [multicenter] study aims to present data on the use, efficacy and safety of SO in patients on HD within the setting of real clinical practice.”
The study included a total of 220 patients who received dialysis treatments at 11 centers, with the researchers noting no influence was placed on prescription decisions of physicians. For 70% of the study population, sucroferric oxyhydroxide therapy was initiated due to “inadequate control” of serum phosphate; for 24.5%, it was initiated to reduce the number of phosphate binder tablets received by patients (average daily number at baseline, 6.3).
Patients were followed for 6 months, after which time the researchers observed a 20% decrease in serum phosphorus with sucroferric oxyhydroxide, as well as a significant reduction in intact parathyroid hormone level. The percentage of patients with adequate serum phosphorous control increased by 45.4% (at threshold level of 5 mg/dL) and 35.9% (at 4.5 mg/dL).
Initiation of sucroferric oxyhydroxide was also shown effective in reducing the number of tablets patients received and increasing treatment adherence.
“After 6 months of treatment the mean number of SO tablets per day was [two], with the maximum number of tablets administered being 3 (41.4% of cases),” the researchers wrote. “At the end of this period, 163 patients (74.1%) were receiving SO treatment as monotherapy, representing an increase of 30% with respect to baseline.”
Regarding adherence, sucroferric oxyhydroxide therapy increased the percentage of patients adhering to treatment by 24.5%.
“Lack of adequate therapeutic adherence is a significant issue in patients with CKD; this is especially true in relation to P binders, with the frequency of inadequate adherence exceeding 60% in those receiving dialysis,” Navarro-González and colleagues wrote regarding the impact of these results. “An appropriate level of compliance is essential in achieving adequate control of serum P and the high number of tablets received by these patients is a determining factor in inadequate therapeutic adherence.”
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