BioTrends Research Group, Inc. recently published two syndicated reports focused on the management of bone and mineral metabolism in the US. ChartTrends®: Bone and Mineral Metabolism is an annual publication based on patient and laboratory data collected from over 1,000 dialysis patient charts. It provides insight into the factors that drive decisions to treat, brand selection, dose and dose changes and switching behavior. TreatmentTrends®: US Nephrology is a quarterly report series based on online survey results from over 100 nephrologists and captures physician attitudes, perceptions and self-reported behavior.
No major changes in the phosphate binder market were observed compared to the prior quarter, however, nephrologists anticipate major changes if phosphate binders and Amgen's Sensipar are included in the dialysis bundle. One expectation is that the use of non-calcium based binders will decrease in favor of less expensive calcium-based options. To date, however, Genzyme's sevelamer remains the market leader in dialysis, based on both reported and audited figures. In the current environment, there are a number of factors identified through patient charts that influence whether a patient will be on a calcium or a non-calcium based binder. A patient's dialysis center, serum calcium level, and time of binder initiation, for example, all play a role. Patients who dialyze in Fresenius units are more likely to be on Fresenius' PhosLo / calcium acetate, while Shire's Fosrenol share is almost double in patients with serum calcium greater than or equal to 10 mg/dL compared to patients with lower serum calcium levels.
Practice patterns have been more variable in the PTH modifier market; both audited active vitamin D and Sensipar treatment prevalence in dialysis are lower this year compared to last year and reported use of nutritional vitamin D in both dialysis and chronic kidney disease non-dialysis patients is trending up. In dialysis, Abbott's Zemplar holds a commanding market share lead over Genzyme's Hectorol, although brand use could change in a bundled environment as increased price pressure could lead to a resurgence of calcitriol, despite potential clinical differences between the three products. Audit data does reveal differences among IV vitamin D products in terms of percent of patients that meet PTH and calcium goals. Even in the current environment, Sensipar continues to be reserved for patients with extremely high PTH, and use is associated with a number of patient demographic variables. Financial issues (out of pocket costs, managed care) are already considered to be the greatest barrier to Sensipar use and if the product is included in the bundle, the challenges to Sensipar would likely worsen, despite current intentions to increase use of the product.
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