Efficacy, Tolerability, and Safety of Lanthanum Carbonate in Hyperphosphatemia: A 6-Month, Randomized, Comparative Trial versus Calcium Carbonate

Abstract

Background/Aims: Hyperphosphatemia is an important clinical consequence of renal failure, and its multiple adverse systemic effects are associated with significantly increased risks of morbidity and mortality in dialysis patients. Existing oral phosphate binders have not permitted control of serum phosphate within currently accepted guidelines. This study compares lanthanum carbonate with calcium carbonate for control of serum phosphate in hemodialysis patients. Methods: In this European multicentre study, 800 patients were randomised to receive either lanthanum or calcium carbonate and the dose titrated over 5 weeks to achieve control of serum phosphate. Serum levels of phosphate, calcium and parathryoid hormone were followed over the following 20 weeks. Results: Around 65% of patients in each group achieved phosphate control, but in the calcium carbonate group this was at the expense of significant hypercalcemia (20.2% of patients vs. 0.4%). Consequently, calcium x phosphate product tended to be better controlled in the lanthanum group. Conclusion: This 6-month study demonstrates that serum phosphate control with lanthanum carbonate (750–3,000 mg/day) is similar to that seen with calcium carbonate (1,500–9,000 mg/day), but with a significantly reduced incidence of hypercalcemia. Lanthanum carbonate is well tolerated and may be more effective in reducing calcium x phosphate product than calcium carbonate.

Long-Term Efficacy and Tolerability of Lanthanum Carbonate: Results from a 3-Year Study

“…The second was a 2-year extension carried out at 34 of these centers in the UK, Germany and Belgium, and was initiated at the request of investigators and patients who participated in the previous phases of the study. The design of the original comparator-controlled trial has been reported elsewhere [25] and is briefly summarized here.…”

“…In a 6-month, randomized, open-label, parallel-group trial comparing lanthanum carbonate with calcium carbonate, lanthanum carbonate was shown to be an effective treatment for hyperphosphatemia with good safety and tolerability [25]. Lanthanum carbonate (750–3,000 mg/day lanthanum) had similar efficacy to calcium carbonate (1,500–9,000 mg/day calcium), although calcium carbonate was associated with a much higher occurrence of hypercalcemia.…”

Fragility Fractures in Chronic Kidney Disease: Assessment and Pharmacologic Management

“…The novel noncalcium based phosphate binders such as sevelamer and lanthanum carbonate may be superior to the calcium based binders as they are associated with less progression of vascular calcification and hypercalcaemia [29,30], although the evidence for patient relevant cardiovascular or bone outcomes is limited [29,30]. Aluminium based phosphate binders are potent phosphate binders but are not suitable for long-term use because of the risk of adynamic bone disease and aluminium toxicity [8,31,32].…”

234: The Effect of Sevelamer Carbonate and Lanthanum Carbonate on the Pharmacokinetics of Oral Calcitriol

“…The dose per day of lanthanum carbonate (3000 mg) was chosen based on the highest doses usually required in clinical studies; most patients received 1500-3000 mg/day in order to reach targets [12,20,21]. Data on the required dosage of sevelamer carbonate are limited; Ketteler et al reported a final mean dose of 7800 mg/day in a recent treat-to-target study [22].…”

“…Several binders are currently available; among these, non-calcium-based lanthanum carbonate (FOSRENOL ® , Shire Pharmaceuticals, Basingstoke, UK) and sevelamer (Renagel ® and Renvela ® , Genzyme Corporation, Cambridge, MA, USA) have been shown to be effective in reducing serum phosphorus levels in patients with CKD on dialysis [11,12] and may improve survival, in comparison with calcium-based binders, in patients over 65 years of age [13,14]. These non-calcium-based binders have been developed as an alternative to the older calcium-based agents, which may increase the progression of calcification [15].…”