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Lanthanum appears to reduce serum phosphorus more than sevelamer in patients with CKD, study suggests

Thursday, October 29 2009 | Comments

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What's This? Among patients with chronic kidney disease (CKD), lanthanum carbonate reduces serum phosphorus to a greater extent than sevelamer hydrochloride, new trial data reveal. However, statistically significant reductions were only observed in the subgroup of patients who completed treatment.

The open-label, 12-week, crossover study included 182 adult patients with CKD who were undergoing hemodialysis 2 to 3 times per week for at least 2 months before screening. Following a wash-out period, the patients were randomized receive lanthanum or sevelamer for 4 weeks; then, after a similar wash-out period, they were switched to the other phosphate binder for the same amount of time.

The study's primary endpoint was change in serum phosphorus from baseline to end of treatment. This endpoint was evaluated using a last-observation-carried-forward approach with the intent-to-treat population (the primary analysis); a secondary analysis examined the completer population, defined as those patients who completed 4 weeks of treatment with both phosphate binders and had a serum phosphorus value at the end of treatment.

Results from the primary analysis showed that there was a numerically greater reduction in serum phosphorus with lanthanum (1.7 mg/dL) than with sevelamer (1.4 mg/dL), but this difference was not statistically significant.

In the completer population (n=119), however, serum phosphorus was reduced by 1.8 mg/dL with lanthanum and by 1.3 mg/dL with sevelamer, a difference that was statistically significant.

"The findings suggest that over four weeks of treatment, [lanthanum] may be a more effective binder of phosphate," said Dr. Stuart Sprague, the lead investigator of the study. "Further research is now required to evaluate whether the trends observed in this crossover study are continued in the long term."

The study was published in the October issue of the journal Clinical Nephrology.

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