Impaired glomerular function manifesting in the advanced stages of chronic kidney disease (CKD) can lead to hyperphosphatemia (elevated serum phosphorus levels). The standard treatment for patients with persistent hyperphosphatemia is a phosphate binder. Several different phosphate binders are available in the United States, and they are predominantly distinguished by their safety and tolerability profile and dosing schedule. Phosphate binders in current use include lanthanum carbonate, calcium-based binders, magnesium-based binders, polymer-based binders, anion-exchange resin-based binders, sevelamer-based binders, as well as iron-based binders.

The iron-based phosphate binders sucroferric oxyhydroxide1 (Fresenius Medical Care North America/Vifor’s Velphoro), and ferric citrate2 (Keryx’s Auryxia), are the latest entrants in the hyperphosphatemia market. In addition to its primary goal of reducing serum phosphorus levels, clinical trial data3 of ferric citrate has shown the potential of a secondary effect of improving renal anemia parameters, such as hemoglobin, transferrin saturation, and serum ferritin. Renal anemia and hyperphosphatemia are both common complications associated with CKD. Thus, boosting renal anemia parameters while reducing serum phosphorus levels is considered to be advantageous for CKD patients.

Phosphate binders are notorious for patient compliance issues, because the pill burden of most currently available therapies is high, and for products like sevelamer-based binders (Genzyme/Sanofi’s Renagel and Renvela)—the patient share leader in CKD dialysis patients in the United States—patients typically take nine pills per day (three per meal). Sucroferric oxyhydroxide on the other hand, has a starting dose of three pills per day in a chewable tablet, a significant reduction in pill burden, with similar efficacy4 to market leading phosphate binders.

There is no doubt that both iron-based phosphate binders possess unique features that differentiate them from each other. But are nephrologists differentiating the two products? Our CurrentTreatment: Hyperphosphatemia 2017 (US)5 study, based on responses from 100 nephrologists, suggests that despite the differing profiles, only half of the surveyed physicians who have prescribed both sucroferric oxyhydroxide and ferric citrate to their patients believe these two hyperphosphatemia therapies are unique from each other. The nephrologists who are cognizant of the difference between the two iron-based phosphate binders cite the renal anemia benefits associated with ferric citrate as the most noticeable difference. Other points of difference include pill burden, palatability, side effects, and cost. Physicians who do not differentiate between the two products believe that overall the two drugs are similar with an almost identical efficacy profile. In-depth analysis of factors that drive and constrain ferric citrate and sucroferric oxyhydroxide treatment, as well as their current and anticipated patient shares based on CKD stage and serum phosphorus levels, are presented in Decision Resources Group’s Current Treatment: Hyperphosphatemia 2017 (US)5 insights.

 

1 http://www.viforpharma.com/en/Media/mediareleases/2013/20131128_velphoro-us.php

2 http://investors.keryx.com/phoenix.zhtml?c=122201&p=irol-newsArticle&ID=1964304

3 http://investors.keryx.com/phoenix.zhtml?c=122201&p=irol-newsArticle&ID=1778277

4 http://www.velphoro.us/hcp/efficacy

5 Decision Resources Group’s CurrentTreatment: Hyperphosphatemia 2017 (US) content provides a deep dive into the “What” and the “Why” of current treatment practices and prescribing patterns for hyperphosphatemia. The report focuses on how patients are being treated today, and what are the key factors behind those treatment decisions. It examines the management of dialysis and mid-to late-stage CKD patients from the perspective of 100 U.S. nephrologists. This content is based on primary market research with expert analysis.

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