Efficacy of PA21 (
sucroferric oxyhydroxide), a novel
calcium-free polynuclear
iron(III)-oxyhydroxide phosphate binder, was compared with that of
sevelamer carbonate in an open-label, randomized, active-controlled phase III study. Seven hundred and seven hemo- and
peritoneal dialysis patients with
hyperphosphatemia received PA21 1.0-3.0 g per day and 348 received
sevelamer 4.8-14.4 g per day for an 8-week dose titration, followed by 4 weeks without dose change, and then 12 weeks maintenance. Serum
phosphorus reductions at week 12 were -0.71 mmol/l (PA21) and -0.79 mmol/l (
sevelamer), demonstrating non-inferiority of, on average, three
tablets of PA21 vs. eight of
sevelamer. Efficacy was maintained to week 24. Non-adherence was 15.1% (PA21) vs. 21.3% (
sevelamer). The percentage of patients that reported at least one treatment-emergent adverse event was 83.2% with PA21 and 76.1% with
sevelamer. A higher proportion of patients withdrew owing to treatment-emergent adverse events with PA21 (15.7%) vs.
sevelamer (6.6%). Mild, transient
diarrhea, discolored feces, and
hyperphosphatemia were more frequent with PA21;
nausea and
constipation were more frequent with
sevelamer. After 24 weeks, 99
hemodialysis patients on PA21 were re-randomized into a 3-week superiority analysis of PA21 maintenance dose in 50 patients vs. low dose (250 mg per day (ineffective control)) in 49 patients. The PA21 maintenance dose was superior to the low dose in maintaining serum
phosphorus control. Thus, PA21 was effective in lowering serum
phosphorus in dialysis patients, with similar efficacy to
sevelamer carbonate, a lower pill burden, and better adherence.