Efficacy and tolerability of lanthanum carbonate in treatment of hyperphosphatemia patients receiving dialysis – a systematic review and meta-analysis of randomized controlled trials

Abstract

Objective:

To evaluate the efficacy and tolerability of lanthanum carbonate (LC) in the treatment of hyperphosphatemia in dialysis patients.

Method:

Multiple databases were used to recruit the published clinical randomized controlled trials (RCTs) comparing LC with placebo for hyperphosphatemia in dialysis patients from inception to March 2013. Results were expressed using standardized mean difference (SMD) for continuous variables and pooled odd ratios (OR) for dichotomous outcomes. Study quality was assessed according to Cochrane Handbook 5.1 guidelines and statistical analysis was performed using RevMan 5.2 software.

Results:

A total of 950 patients in seven placebo-controlled RCTs were included. Results showed that LC could effectively controlled hyperphosphatemia compared with placebo (SMD −1.06, 95% CI −1.27–−0.86, P < 0.00001). The proportion of subjects reaching the target in the LC group was higher than that in the placebo group (OR 6.88, 95% CI 4.39–10.78, P < 0.00001). LC-treated patients showed less change in serum PTH and Ca × Pi product from baseline compared to the placebo group (SMD −0.21, 95% CI −0.48–0.06, P = 0.007; SMD −0.90, 95% CI −1.13–−0.66, P < 0.00001, respectively). LC-treated patients experienced more side-effects, like vomiting and nausea, than controls (OR 3.10, 95% CI 1.35–7.08, P = 0.007; OR 2.74, 95% CI 1.22–6.19, P = 0.02, respectively). But overall, the incidence of drug-related adverse events was similar between placebo- and LC-treated patients (OR 1.21, 95% CI 0.66–2.22, P = 0.54).

Conclusion:

In the treatment of hyperphosphatemia in dialysis patients, LC is well tolerated and more effective than placebo during short-term trials. Furthermore, it helps to maintain PTH and Ca × Pi product levels within recommended ranges. LC is an ideal choice for second-line treatment of hyperphosphatemia after therapy failure or other contraindication for calcium agents. Its long-term security still needs further research.

Keywords::

• Chronic kidney failure
• Hyperphosphatemia
• Lanthanum carbonate
• Phosphate binders
• Renal dialysis

Transparency

Declaration of funding

No sponsors were involved in study design; in the collection, analysis and interpretation of data; in the writing of the report and in the decision to submit the report for publication. All authors had access to the raw data.

Declaration of financial/other relationships

W.H., J.L., Y.T., X.G., B.D., and F.Z. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgments

The authors would like to thank Professor Kehu Yang and Associate Professor Jinhui Tian (Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, China) for their contributions of technical help and writing assistance to this study.

Notes

*Fosrenol is a registered trade name of Shire Pharmaceutical Contracts Limited, UK