title: Higher strength lanthanum carbonate provides serum phosphorus control with a low tablet burden and is preferred by patients and physicians: a multicenter study.
abstract: OBJECTIVE
  Management of hyperphosphatemia, a predictor of mortality in chronic kidney disease, is challenging. Nonadherence to dietary phosphate binders, in part, contributes to uncontrolled serum phosphorus levels. This phase IIIb trial assessed the efficacy of increased dosages (3000 to 4500 mg/d) of reformulated lanthanum carbonate (500-, 750-, and 1000-mg tablets) in nonresponders to dosages of up to 3000 mg/d.
  
  
  METHODS
  This 8-wk study with a 4-mo open-label extension enrolled 513 patients who were undergoing maintenance hemodialysis. Patients who achieved serum phosphorus control at week 4 with <or=3000 mg/d lanthanum carbonate entered cohort A; nonresponders were randomly assigned to receive 3000, 3750, or 4500 mg/d (cohort B). The primary outcome measure was the control rate for predialysis serum phosphorus levels at the end of week 8, among patients in cohort B.
  
  
  RESULTS
  At the end of week 4, 54% of patients achieved serum phosphorus control at dosages <or=3000 mg/d administered as one tablet per meal. Among patients who entered cohort B, control rates of 25, 38, and 32% for patients who were randomly assigned to 3000, 3750, or 4500 mg/d lanthanum carbonate, respectively, were achieved, with no increase in adverse events. Patients and physicians reported significantly higher levels of satisfaction with reformulated lanthanum carbonate compared with previous phosphate binders, partly because of reduced tablet burden with higher dosage strengths. Physicians and patients also expressed a preference for lanthanum carbonate over previous medication.
  
  
  CONCLUSIONS
  Reformulated lanthanum carbonate is an effective phosphate binder that may reduce daily tablet burden.
authors.affiliation: Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA. rmehrotra@labiomed.org
authors.forename: Rajnish
authors.initials: R
authors.lastname: Mehrotra
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Martin
authors.forename: Steven
authors.initials: S
authors.lastname: Fishbane
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Sprague
authors.forename: Steven
authors.initials: S
authors.lastname: Zeig
authors.forename: Michael
authors.initials: M
authors.lastname: Anger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D007674:Kidney Diseases / Q000150:complications / Q000188:drug therapy / Q000378:metabolism / Q000628:therapy*; D007811:Lanthanum / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010758:Phosphorus / Q000097:blood*; D006435:Renal Dialysis; D013607:Tablets; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D013607:Tablets; D010758:Phosphorus; C119467:lanthanum carbonate; D007811:Lanthanum