Switching to lanthanum carbonate monotherapy provides effective phosphate control with a low tablet burden.
BACKGROUND
Despite recognized risks associated with hyperphosphataemia in patients with chronic kidney disease (CKD) Stage 5 on dialysis, the achievement of target levels of serum phosphate is poor. It is likely that this is partly due to poor adherence by patients to their phosphate-binder treatment regimens, which often comprise large daily tablet burdens.


METHODS
In this multicentre, open-label trial, patients on a stable dialysis regimen were screened while receiving phosphate-binder therapy, then entered into a washout phase. Patients with serum phosphate > 1.78 mmol/L after washout entered into the main 12-week treatment phase (N = 367), during which they were treated to target [Kidney Disease Outcomes Quality Initiative (K/DOQI)]: 1.13-1.78 mmol/L; 3.5-5.5 mg/dL) with lanthanum carbonate monotherapy. Efficacy variables included serum phosphate levels and the percentage of patients with serum phosphate control. Safety and tolerability assessments were also conducted.


RESULTS
Mean serum phosphate levels were significantly reduced following 12 weeks of lanthanum carbonate monotherapy versus previous phosphate-binder therapy. The mean number of phosphate-binder tablets being taken per day at screening was 7.6, but during treatment with lanthanum carbonate, most patients were taking doses of up to 3000 mg/day, achievable with 3 x 1000 mg tablets per day (maximum of 6).


CONCLUSIONS
These findings suggest that lanthanum carbonate monotherapy offers effective control of serum phosphate and, due to a low tablet burden, may help to simplify the management of hyperphosphataemia in patients with CKD Stage 5.
Hutchison
Alastair J
AJ
Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester, UK. alastair.hutchison@cmmc.nhs.uk
Laville
Maurice
M
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood; D002170:Canada; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D005060:Europe; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood* / Q000209:etiology / Q000517:prevention & control*; D007557:Israel; D007674:Kidney Diseases / Q000150:complications* / Q000628:therapy; D007811:Lanthanum / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood*; D011446:Prospective Studies; D006435:Renal Dialysis; D016896:Treatment Outcome
D010281:Parathyroid Hormone; D010710:Phosphates; C119467:lanthanum carbonate; D007811:Lanthanum; D002118:Calcium