Real-world effectiveness of sucroferric oxyhydroxide in patients on chronic hemodialysis: A retrospective analysis of pharmacy data

Abstract

Aims: Hyperphosphatemia has been associated with an increased risk of mortality in patients with end-stage renal disease. We sought to assess the real-world effectiveness of sucroferric oxyhydroxide (SO), an iron-based phosphate binder (PB), in control of serum phosphorus levels, and to determine the associated pill burden in hemodialysis patients.

Materials and methods: Adult, in-center hemodialysis patients first prescribed SO through a renal pharmacy service as part of routine clinical care between April 1, 2014 and March 31, 2015 were included in the analysis. The proportion of patients with phosphorus levels ≤ 5.5 mg/dL and the mean prescribed PB pills/day were compared between baseline (3 months prior to SO) and SO follow-up at 3 (SO 1 - 3) and 6 months (SO 4 - 6). Mineral bone disease markers, hemoglobin, iron indices, and erythropoiesis-stimulating agents and intravenous iron use were assessed.

Results: At baseline, all patients (n = 1,029) were prescribed PB, and 13.9% had mean serum phosphorus ≤ 5.5 mg/dL. Comparing baseline to SO 1 - 3, the mean prescribed PB pills/day declined from 9.6 to 3.8 pills/day (p < 0.001), and the proportion of patients with serum phosphorus ≤ 5.5 mg/dL increased from 13.9 to 26.1% (+88%). Comparing baseline to SO 4 - 6 (n = 424), the mean prescribed PB pills/day declined from 9.7 to 4.0 pills/day (p < 0.001), and the proportion of patients with serum phosphorus ≤ 5.5 mg/dL increased from 15.6 to 30.4% (+95%).

Conclusions: Prescription of SO was associated with an increase in the proportion of patients achieving serum phosphorus levels ≤ 5.5 mg/dL along with fewer prescribed PB pills/day. .

Figure 1.. Change in percentage of patients with serum phosphorus ≤ 5.5 mg/dL switching from all phosphate binders (all PB), sevelamer (Sev), calcium acetate (CaAc), and lanthanum carbonate (LC) to sucroferric oxyhydrase (SO).

Figure 2.. Change in distribution of patients across different serum phosphorus categories at baseline and during sucroferric oxyhydrase (SO) treatment.

Figure 3.. Patient disposition. The SO 1 – 3 cohort included 1,029 patients. The SO 4 – 6 cohort included 424 patients, and 605 patients were not included. Figure 3 shows the disposition of 605 patients not included in SO 4 – 6 cohort. *Discharge due to transfer, transplant, or death. FKC = Fresenius Kidney Care; PB = phosphate binder; SO = sucroferric oxyhydroxide; sP = serum phosphorus.