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Next-Generation Phosphate Binders: Focus on Iron-Based Binders

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Abstract

Phosphate excess is associated with increased mortality in patients with chronic kidney disease (CKD) and has recently been linked to accelerated aging. Oral phosphate binders are prescribed to patients with CKD to prevent absorption of dietary phosphate. Currently available binders have been associated with impaired outcomes (calcium-based binders) or are expensive (non-calcium-based binders). Iron-based phosphate binders represent a new class of phosphate binders. Four iron-based phosphate binders have undergone testing in clinical trials. The development of fermagate and SBR759 is currently on hold due to suboptimal and adverse effect profiles in at least some clinical trials. Ferric citrate and sucroferric oxyhydroxide (PA21) are at different stages of application for regulatory approval after being found safe and efficacious in decreasing serum phosphate. Iron from ferric citrate is more readily absorbed than that from sucroferric oxyhydroxide. Sucroferric oxyhydroxide was launched in the USA in 2014 for the treatment of hyperphosphatemia in adult dialysis patients. Ferric citrate may be more suited for chronic treatment of hyperphosphatemia in CKD patients requiring iron supplements but its use may have to be limited in time because of potential for iron overload in patients not needing iron or not receiving erythropoiesis-stimulating agents. In contrast, sucroferric oxyhydroxide may be more suited for hyperphosphatemic CKD patients not requiring iron supplements.

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Sources of support that require acknowledgment

Grant support: FIS PS09/00447, PI13/00047, ISCIII-RETIC REDinREN/RD06/0016/ and RD012/0021 FEDER funds, Comunidad de Madrid/CIFRA S2010/BMD-2378. Salary support: FIS to MDSN (Sara Borrell), BFF Hortega), AO (Programa Intensificación Actividad Investigadora), ERA-EDTA (LGE, UE).

Conflict of interest

DN, BFF, UE, LGE have no conflicts of interest. MDSN has received travel support from Genzyme. EGP has received consulting honoraria, speaker fees, or research or travel support from Abbvie, Shire, and Sanofi. AO has received consulting honoraria, speaker fees, or research or travel support from Sanofi, Genzyme, Fresenius Medical Care, Amgen, Shire, Baxter, Rubió, and Abbott.

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Authors and Affiliations

  1. Hellenic Red Cross Hospital, Athens, Greece

    Dimitra Nastou

  2. Unidad de Diálisis, IIS-Fundación Jiménez Díaz, Avda. Reyes Católicos 2, 28040, Madrid, Spain

    Beatriz Fernández-Fernández, Usama Elewa, Liliana González-Espinoza, Emilio González-Parra & Alberto Ortiz

  3. REDINREN, Madrid, Spain

    Beatriz Fernández-Fernández, Usama Elewa, Liliana González-Espinoza, Emilio González-Parra, Maria D. Sanchez-Niño & Alberto Ortiz

  4. IDIPAZ, Madrid, Spain

    Maria D. Sanchez-Niño

  5. IRSIN Universidad Autónoma de Madrid, Madrid, Spain

    Alberto Ortiz

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  1. Dimitra Nastou
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  3. Usama Elewa
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Correspondence to Alberto Ortiz.

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D. Nastou and B. Fernández-Fernández contributed equally.

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Nastou, D., Fernández-Fernández, B., Elewa, U. et al. Next-Generation Phosphate Binders: Focus on Iron-Based Binders. Drugs 74, 863–877 (2014). https://doi.org/10.1007/s40265-014-0224-6

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