Colestilan for the treatment of hyperphosphatemia in chronic kidney disease patients on dialysis

Abstract

Chronic kidney disease in the later stages poses many treatment challenges. Hyperphosphatemia is one that is well-known and is often linked to increased cardiovascular morbidity/mortality. Currently, a number of phosphate binders are available that act to conserve serum phosphate at normal or near normal levels. However, it is the overall profile of all binders that needs to be taken into account and the risks and the potential benefits associated with each agent must be balanced when selecting a particular phosphate binder. It is known that calcium-based binders, although effective phosphate binders, may lead to hypercalcemia and/or positive calcium balance and cardiovascular calcification. One, new non-calcium phosphate binder, recently approved in Europe, is colestilan. Colestilan possesses a range of properties that may afford further advantages over simply reducing serum phosphate. This review assesses the pharmacology and clinical data of colestilan used to treat hyperphosphatemia in chronic kidney disease stage 5 patients on dialysis. The article was written based on literature searches using PubMed to find articles published on phosphate binders or colestilan over the last 10 years.

Keywords:

• chronic kidney disease
• colestilan
• dialysis
• hyperphosphatemia
• phosphate binders

Financial & competing interests disclosure

F Locatelli is the member of the advisory boards and/or speaker for AbVie, Akebia Therapeutics, Amgen Inc., Fibrogen, Janssen Pharmaceuticals, GlaxoSmithKline, Keryx, Mitsubishi Tanabe Pharma Europe Ltd, Roche, Vifor-Fresenius Medical Care (Vifor Pharma). N Dimkovic and G Spasovski are members of the advisory board for Mitsubishi Tanabe Pharma Europe Ltd. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Colestilan is a non-calcium, non-metal-based phosphate binder that is licensed in Europe for the treatment of hyperphosphatemia in dialysis patients. The effectiveness and safety has been shown.

• In addition, there are additional actions that may well confer additional benefits. The formulations could offer some advantages in terms of patient preference and thus possibly patient compliance.

• Key issues remaining would include a better understanding of the relative efficacy versus other agents, particularly relative effects versus calcium binders on vascular calcification, an understanding of its use in the pediatric population, its efficacy when used in combination with other binders and a deeper understanding of how colestilan lowers high HbA1c and uric acid in this patient population.

Notes