ChartTrends(R): Bone and Mineral Metabolism in Dialysis Reveals Latest Trends in the Treatment of Calcium, Phosphorus and PTH
This ChartTrends(R) report sheds light on patient demographics, laboratory values, and treatment prevalence with phosphate binders, Nutritional Vitamin D, Active Vitamin D and Sensipar. Moreover, it provides information on the interplay between these therapies and uncovers actual (as opposed to self-reported) product dosing and titration, brand switching and reasons for switching, as well as brand persistency.
In the treatment of hyperphosphatemia, patients tend to be initiated on phosphate binder monotherapy when phosphorus reaches 5.7 mg/dL. Phosphorus levels are significantly higher when combination therapy is initiated. Contrary to what Nephrologists perceive based on self-reported data, combination binder therapy is prescribed infrequently. Genzyme’s sevelamer is the market share leader despite the fact that it has the highest pill burden. Shire’s Fosrenol has the lowest pill burden, but significantly lower persistency compared to Renagel, Tums and FMC’s PhosLo. Within the sevelamer franchise, patient conversion to Renvela stands at about 27% and about half of the Renvela patients had been switched from Renagel.
The vast majority of dialysis patients are on Active Vitamin D formulations such as Abbott’s Zemplar and Genzyme’s Hectorol. The use of Nutritional Vitamin D (i.e. ergocalciferol) appears to be increasing and the concomitant use of Nutritional Vitamin D does have an impact on the dose of Active Vitamin D. Although the use of Active Vitamin D is widespread, a substantial number of patients are still above the target level for iPTH.
Amgen’s Sensipar tends to be reserved for difficult to control patients and is initiated at a mean iPTH of 669 pg/mL, with more than one-quarter of patients being initiated when iPTH >750 pg/mL. Although MD perception is that treatment with Sensipar can result in lower doses of Vitamin D and phosphate binders, the converse is actually true. Patients treated with Sensipar tend to be on higher doses of both agents. Despite more aggressive therapy, a significant proportion of these patients remain uncontrolled.
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