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A comparative review of the efficacy and safety of established phosphate binders: calcium, sevelamer, and lanthanum carbonate.
Curr Med Res Opin. 2007 Dec; 23(12):3167-75.CM

Abstract

BACKGROUND

Obstacles to successful management of hyperphosphatemia in chronic kidney disease include inadequate control of dietary phosphate and non-compliance with phosphate-binder therapy. Three major classes of phosphate binders include calcium-based binders, sevelamer HCl, and lanthanum carbonate.

SCOPE

A literature search was performed using MEDLINE and EMBASE databases to identify clinical trials from January 1966 to May 2007 comparing classes of phosphate binders with regard to efficacy, safety, compliance, or pharmacoeconomics. Search terms included lanthanum AND sevelamer, lanthanum AND calcium, and sevelamer AND calcium. A total of 1372 articles were identified in the search, with 125 review articles and clinical trials of interest identified.

FINDINGS

Calcium-based binders are effective, but their potential to contribute to total body calcium overload and vascular calcification is an important long-term clinical concern. Sevelamer HCl is effective in reducing serum phosphate, has no systemic absorption, and does not increase total body calcium load. However, sevelamer HCl binds bile acids, is not an efficient phosphate binder in an acidic environment, and contributes to metabolic acidosis. Lanthanum carbonate is a potent and selective phosphate binder that retains high affinity for phosphate over a wide pH range, does not bind bile acids or contribute to metabolic acidosis, and has the potential to reduce pill burden and increase patient compliance compared with other phosphate binders.

CONCLUSIONS

All three classes of phosphate binders are effective at reducing serum phosphate levels. Lanthanum carbonate may result in increased adherence by decreasing the pill burden.

Authors+Show Affiliations

Division of Nephrology and Hypertension, Evanston Northwestern Healthcare, Northwestern University Feinberg School of Medicine, Evanston, IL 60201, USA. ssprague@northwestern.edu

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Review

Language

eng

PubMed ID

17991307

Citation

Sprague, Stuart M.. "A Comparative Review of the Efficacy and Safety of Established Phosphate Binders: Calcium, Sevelamer, and Lanthanum Carbonate." Current Medical Research and Opinion, vol. 23, no. 12, 2007, pp. 3167-75.
Sprague SM. A comparative review of the efficacy and safety of established phosphate binders: calcium, sevelamer, and lanthanum carbonate. Curr Med Res Opin. 2007;23(12):3167-75.
Sprague, S. M. (2007). A comparative review of the efficacy and safety of established phosphate binders: calcium, sevelamer, and lanthanum carbonate. Current Medical Research and Opinion, 23(12), 3167-75.
Sprague SM. A Comparative Review of the Efficacy and Safety of Established Phosphate Binders: Calcium, Sevelamer, and Lanthanum Carbonate. Curr Med Res Opin. 2007;23(12):3167-75. PubMed PMID: 17991307.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparative review of the efficacy and safety of established phosphate binders: calcium, sevelamer, and lanthanum carbonate. A1 - Sprague,Stuart M, PY - 2007/11/10/pubmed PY - 2008/2/23/medline PY - 2007/11/10/entrez SP - 3167 EP - 75 JF - Current medical research and opinion JO - Curr Med Res Opin VL - 23 IS - 12 N2 - BACKGROUND: Obstacles to successful management of hyperphosphatemia in chronic kidney disease include inadequate control of dietary phosphate and non-compliance with phosphate-binder therapy. Three major classes of phosphate binders include calcium-based binders, sevelamer HCl, and lanthanum carbonate. SCOPE: A literature search was performed using MEDLINE and EMBASE databases to identify clinical trials from January 1966 to May 2007 comparing classes of phosphate binders with regard to efficacy, safety, compliance, or pharmacoeconomics. Search terms included lanthanum AND sevelamer, lanthanum AND calcium, and sevelamer AND calcium. A total of 1372 articles were identified in the search, with 125 review articles and clinical trials of interest identified. FINDINGS: Calcium-based binders are effective, but their potential to contribute to total body calcium overload and vascular calcification is an important long-term clinical concern. Sevelamer HCl is effective in reducing serum phosphate, has no systemic absorption, and does not increase total body calcium load. However, sevelamer HCl binds bile acids, is not an efficient phosphate binder in an acidic environment, and contributes to metabolic acidosis. Lanthanum carbonate is a potent and selective phosphate binder that retains high affinity for phosphate over a wide pH range, does not bind bile acids or contribute to metabolic acidosis, and has the potential to reduce pill burden and increase patient compliance compared with other phosphate binders. CONCLUSIONS: All three classes of phosphate binders are effective at reducing serum phosphate levels. Lanthanum carbonate may result in increased adherence by decreasing the pill burden. SN - 1473-4877 UR - https://www.unboundmedicine.com/medline/citation/17991307/A_comparative_review_of_the_efficacy_and_safety_of_established_phosphate_binders:_calcium_sevelamer_and_lanthanum_carbonate_ L2 - https://www.tandfonline.com/doi/full/10.1185/030079907X242719 DB - PRIME DP - Unbound Medicine ER -