title: A phase III study of the efficacy and safety of a novel iron-based phosphate binder in dialysis patients.
abstract: Efficacy of PA21 (sucroferric oxyhydroxide), a novel calcium-free polynuclear iron(III)-oxyhydroxide phosphate binder, was compared with that of sevelamer carbonate in an open-label, randomized, active-controlled phase III study. Seven hundred and seven hemo- and peritoneal dialysis patients with hyperphosphatemia received PA21 1.0-3.0 g per day and 348 received sevelamer 4.8-14.4 g per day for an 8-week dose titration, followed by 4 weeks without dose change, and then 12 weeks maintenance. Serum phosphorus reductions at week 12 were -0.71 mmol/l (PA21) and -0.79 mmol/l (sevelamer), demonstrating non-inferiority of, on average, three tablets of PA21 vs. eight of sevelamer. Efficacy was maintained to week 24. Non-adherence was 15.1% (PA21) vs. 21.3% (sevelamer). The percentage of patients that reported at least one treatment-emergent adverse event was 83.2% with PA21 and 76.1% with sevelamer. A higher proportion of patients withdrew owing to treatment-emergent adverse events with PA21 (15.7%) vs. sevelamer (6.6%). Mild, transient diarrhea, discolored feces, and hyperphosphatemia were more frequent with PA21; nausea and constipation were more frequent with sevelamer. After 24 weeks, 99 hemodialysis patients on PA21 were re-randomized into a 3-week superiority analysis of PA21 maintenance dose in 50 patients vs. low dose (250 mg per day (ineffective control)) in 49 patients. The PA21 maintenance dose was superior to the low dose in maintaining serum phosphorus control. Thus, PA21 was effective in lowering serum phosphorus in dialysis patients, with similar efficacy to sevelamer carbonate, a lower pill burden, and better adherence.
authors.affiliation: Division of Nephrology, RWTH University Hospital Aachen, Aachen, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Floege
authors.affiliation: 8216;Grigore T Popa' University of Medicine and Pharmacy, Iasi, Romania.
authors.forename: Adrian C
authors.initials: AC
authors.lastname: Covic
authors.affiliation: Coburg Clinic and KfH-Dialysis Center, Coburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Ketteler
authors.affiliation: University of California, Los Angeles, California, USA.
authors.forename: Anjay
authors.initials: A
authors.lastname: Rastogi
authors.affiliation: Vifor Pharma, Glattbrugg, Switzerland.
authors.forename: Edward M F
authors.initials: EM
authors.lastname: Chong
authors.affiliation: Vifor Pharma, Glattbrugg, Switzerland.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Gaillard
authors.affiliation: Vifor Pharma, Glattbrugg, Switzerland.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Lisk
authors.affiliation: NorthShore University Health System University of Chicago Pritzker School of Medicine, Evanston, Illinois, USA.
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Sprague
mesh_terms: D000328:Adult; D000368:Aged; D002614:Chelating Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003248:Constipation / Q000139:chemically induced; D003967:Diarrhea / Q000139:chemically induced; D005260:Female; D005290:Ferric Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D060828:Induction Chemotherapy; D060046:Maintenance Chemotherapy; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D010352:Patient Dropouts; D010530:Peritoneal Dialysis; D010758:Phosphorus / Q000097:blood*; D011073:Polyamines / Q000009:adverse effects / Q000627:therapeutic use; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy; D000069603:Sevelamer
chemical_list: D002614:Chelating Agents; D005290:Ferric Compounds; C552479:PA21 compound; D011073:Polyamines; D010758:Phosphorus; D000069603:Sevelamer