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Patiromer: A Review in Hyperkalaemia

Abstract

Patiromer (Veltassa) for oral suspension is a sodium-free potassium binder that is approved in the USA for the treatment of hyperkalaemia. In clinical trials, patiromer significantly reduced serum potassium levels from baseline to week 4 in patients with chronic kidney disease (CKD) and mild to severe hyperkalaemia (OPAL-HK), or CKD, mild to moderate hyperkalaemia and type 2 diabetes mellitus (AMETHYST-DN), who were receiving renin-angiotensin-aldosterone system inhibitors (RAASis; drugs that inhibit the renal excretion of potassium). Among patients in OPAL-HK who had moderate to severe hyperkalaemia at baseline and normokalaemia on patiromer and RAASis at week 4, continuing patiromer for a further 8 weeks maintained reductions in potassium levels more effectively than switching to placebo (i.e. withdrawing patiromer); consequently, fewer patiromer than placebo recipients experienced recurrent hyperkalaemia during this period. Furthermore, almost all patiromer (vs. less than half of placebo) recipients were still receiving RAASi therapy at the end of this trial. In AMETHYST-DN, the significant reduction from baseline in serum potassium levels seen at week 4 was sustained for up to 52 weeks. Patiromer was generally well tolerated in these trials, with no treatment-related serious adverse events or deaths. Commonly occurring treatment-related adverse events include mild to moderate constipation and hypomagnesaemia, and there is a low risk of hypokalaemia. In conclusion, oral patiromer is a useful new option for patients with hyperkalaemia.

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Acknowledgments

During the peer review process, the manufacturer of patiromer was also offered an opportunity to review this article. Changes resulting from comments received were made on the basis of scientific and editorial merit.

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Correspondence to E. S. Kim.

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Funding

The preparation of this review was not supported by any external funding.

Conflict of interest

Esther Kim and Emma Deeks are salaried employees of Adis/Springer, are responsible for the article content and declare no relevant conflicts of interest.

Additional information

The manuscript was reviewed by: D. Batlle, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; S. Shirazian, Division of Nephrology, Department of Medicine, Winthrop University Hospital, Mineola, NY, USA.

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Cite this article

Kim, E.S., Deeks, E.D. Patiromer: A Review in Hyperkalaemia. Clin Drug Investig 36, 687–694 (2016). https://doi.org/10.1007/s40261-016-0432-9

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Keywords

  • Chronic Kidney Disease
  • Serum Potassium
  • Less Square Mean
  • Serum Potassium Level
  • Diabetic Kidney Disease