Abstract: PUB064
Reducing Pill Burden of Phosphate Binders Has the Potential to Improve Patient Adherence
Session Information
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Modi, Nishit, Unicycive Therapeutics, Inc, Los Altos, California, United States
- Gupta, Shalabh, Unicycive, Los Altos, California, United States
Background
Pill burden and medication intolerance are important factors that influence phosphate binder adherence for managing hyperphosphatemia. The number and size of pills are key factors contributing to pill burden. We compared the pill burden of currently approved phosphate binders with lanthanum dioxycarbonate (RenaZorb), second-generation, lanthanum-based drug in development to evaluate its potential for improving patient adherence.
Methods
A literature analysis of phosphate-binding medications were examined to assess the impact of pill size and pill number on non-adherence in hemodialysis patients. We also compared their equivalent doses relative to the phosphorus binding capacity of 1 g calcium carbonate (PBED) in table 1.
Results
Amongst approved phosphate binders lanthanum carbonate and sucroferric oxyhydroxide have lower pill burden than other phosphate binders but higher discontinuation rates than some due to patient intolerance. Phase 1 data for lanthanum dioxycarbonate1, suggest comparable urinary excretion of phosphate to published data for lanthanum carbonate.
Conclusion
Lanthanum dioxycarbonate has the potential to significantly improve patient compliance by offering a lower-in-class pill burden and smaller sized tablets to achieve similar therapeutic benefit as other phosphate binders.
Reference: 1Finn WF, DenupCiocca CJ, Joy MS et al. Double-Blind Dose-Ranging Study of Lanthanum Dioxycarbonate (Renazorb) in Healthy Volunteers Shows High Phosphorous Binding Capacity. Kidney Week 2013, Atlanta, GA, Nov 5-10
Dosages of selected phosphate binders required to reach a phosphorous binder equivalent dose (PBED). Table is modified from St. Peter2
| Phosphate binder | Tablet strength (mg) | Tablet Size (mm) | Dose of binder needed to reach a PBED of 6 g/daya | Approximate number of tablets to reach PBED of 6 g day | Grams of calcium in 6 g PBED dose |
| Calcium carbonate | 648 | 11 | 6 | 8 | 2.4 |
| Calcium acetate | 667 | 13 | 6 | 9 | 1.5 |
| Lanthanum Carbonate | 500b | 18 | 3 | 6 | 0 |
| Sevelamer carbonate | 800 | 19-21 | 8 | 10 | 0 |
| Sucroferric oxyhydroxide | 500 | 20 | 1.5 | 3.75 | 0 |
| Ferric citrate | 210 | 19 | 2 | 9 | 0 |
| Lanthanum dioxycarbonate | 500 | 11 | 2.1 | 4 | 0 |
a In US dialysis patients, PBED averages around 6 g/day. This means that patients require 6 g/day of calcium carbonate to control their serum phosphorous. b Tablets are sold by weight of lanthanum and not of lanthanum carbonate. 2 WL. St Peter, LD Wazny, E Weinhandl et al. Drugs, 2017, 77:1155-1186
Funding
- Commercial Support – Unicycive Therapeutics Inc.