Niacin as a drug repositioning candidate for hyperphosphatemia management in dialysis patients

Figures & data

Figure 1 Order frequency of niacin versus statins in a single tertiary-care institution.

Note: The number of medical orders for niacin, niacin-laropiprant, and pitavastatin are near zero.

Figure 2 Order frequency of niacin versus sevelamer in a single tertiary-care institution.

Table 1 Summary of the selected clinical trials of niacin and nicotinamide in end-stage renal disease patients on dialysis

Trial	Active (A) group	Control (C) group	No of patients (A/C), n	Treatment duration	Baseline serum P, mg/dL	Mean age, years	Mean duration of dialysis	Treatment intervention with dose titration, mg/day	Other phosphate binder use	Mean P decrease, mg/dL	Mean Ca change, mg/dL	Ca-P product decrease, mg^2/dL^2	Adverse events, n	Statin use, %	Lipid parameters
12	Nicotinamide	None	65/0	12 weeks	>6.0	57.0±11.5	6.5±5.2 years, 3 times weekly	500, increased by 250 every 2 weeks	No	1.5 (P<0.0001)	NS	12.5 (P<0.0001)	D: 5 T: 1	NR	HDL: ↑ LDL: ↓ TG: NS
13	Niacin ER	None	34/0	8 weeks	>6.0	48±13	8.7±9.6 months, 2 times weekly	375, increased to twice daily after 2 weeks	No	2.1 (P<0.001)	Increased by 0.4 (P<0.015)	14.4 (P<0.001)	Mild Pr: 2	NR	NR
14	Niacin ER	None	17/0	12 weeks	5.7±0.4	65.4±10.2	3.8±2.1 years	375, increased to 500, 1,000, 1,500, and 2,000 every 2 weeks	No	1.3 (P=0.015)	NS	NR	F: 7 D: 1	65	HDL: ↑ LDL: NS TG: NS
15	Niacin ER	None	9/0	8 months	>5.5	48.2	34.7 months	500, increased to 1,000 after 3 months	No	2.52 (P<0.01)	Increased by 0.62 (P<0.05)	~20	None observed	NR	HDL: ↑ LDL: NS TG: ↓
24	Nicotinamide	Placebo crossover	33/33	20 weeks	>5.0	52.6	4.4 years	500, increased to 1,000 and 1,500 every 2 weeks	Yes	0.79 (P=0.02)	NS	7 (P=0.02)	T: 9 D: 1 R: 1	NR	HDL: ↑ LDL: NS TG: NS
25	Nicotinamide	Placebo	8/7	8 weeks	>4.9	53.4±10.9	18±11 months	500, increased to 1,000 and 1,500 every 2 weeks	Yes	0.7±0.9, between-group difference 1.1 (P=0.037)	Increased by 0.3	Unchanged	D: 1 R: 1	75	HDL: NS LDL: NS TG: NS
26	Nicotinamide	Placebo	24/24	8 weeks	≥5	A group: 53.9±11.1 C group: 54.1±16.6	A group: 40±37 months C group: 37±28 months	500, increased to 1,000 after 4 weeks	Yes	4 weeks: 1.13 (P=0.002) 8 weeks: 1.24 (P=0.000)	NS	4 weeks: 9.5 (P=0.004) 8 weeks: 10.49 (P=0.002)	T: 10 D: 4	NR	HDL: ↑ LDL: ↓ TG: NS
18	Niacin ER	Placebo	14/14	12 weeks	>5.5	A group: 45.5±11.5 C group: 49.4±10.9	A group: 9.3±3.9 years C group: 9.6±4.7 years	375, increased to 500, 750, and 1,000 weekly	Yes	1.48 (P<0.001), between-group difference NS	NS	~13 (P<0.001)	F: 1	50	HDL: ↑
27	Niacin ER	Placebo crossover	37/37	8 weeks	5–7	57±11	NR	400, increased to 600, 800, and 1,000 every 2 weeks	Yes	0.7 (P=0.006)	NS	NR	F: 3 GI: 2 Mild Pr: 7	NR	HDL: ↑ LDL: NS TG: NS
28	Niacin ER	Sevelamer HCl	20/20	4 weeks	>6	A group: 51±16.1 C group: 48.5±15.5	A group: 6.0±4.4 years C group: 5.6±5.3 years	500	No	A group: 1.7±1 (P=0.004) C group: 2.2±0.6 (P<0.0001), between-group difference NS	NS	A group: 16.3±11 (P=0.007) C group: 21.6±7 (P<0.0001), between-group difference NS	F: 5	NR	HDL: NS LDL: NS TG: ↓

Notes: ↑, increased; ↓, decreased.

Abbreviations: D, diarrhea; F, flushing; HDL, high-density lipoprotein; LDL, low-density lipoprotein; NR, not reported; NS, not significant; Pr, pruritus; R, rash; ER, extended release; HCl, hydrochloride; GI, gastrointestinal; Ca-P, calcium-phosphorus; T, thrombocytopenia; TG, triglycerides.