EXTON, Pa., Aug. 3, 2017 /PRNewswire/ -- According to the latest RealWorld Dynamix: Dialysis report, more than one-third of the dialysis patients were above target levels (5.5mg/dL). The majority of both hemodialysis (HD) and peritoneal dialysis (PD) patients take phosphate binders and a small proportion take more than one binder as combination therapy. According to the treating nephrologist, the primary goal of combining binders is to improve efficacy; however, our analysis revealed that phosphate control was significantly worse when binders were used in combination, regardless of which brands were used.
The study also underscored the issue of pill burden in this patient population. According to the audits, HD patients take an average of 9.3 different medications, many of which, like phosphate binders are taken multiple times per day. Dialysis patients on Sanofi's Renvela have a significantly higher pill burden compared to all other binder brands, yet despite 82% of the nephrologists claiming that pill burden is the greatest issue affecting patient compliance, Renvela is still the market share leader by a healthy margin.
The nephrologists reported that about a third of their dialysis patients are currently on Amgen's Sensipar, however, the audited figures indicated lower exposure rates, with more than 20% of those started on the drug discontinuing. More than 50% of the Sensipar discontinuations were related to adherence issues, market access/cost issues or GI tolerability, all barriers that may be minimized once Parsabiv, Amgen's recently approved calcimimetic, becomes available. More than two-thirds of the Sensipar-treated patients also take active vitamin D, although the brands and formulation differed widely by dialysis center affiliation.
The audit also assessed anemia treatment patterns, evaluating the dosing patterns for ESAs and IV iron along with corresponding hemoglobin, TSAT and ferritin levels as well as patient-reported symptoms. Fatigue was the most commonly reported symptom among dialysis patients and a stepwise pattern was observed between hemoglobin level and reports of fatigue. Indeed, more than half of the patients with a hemoglobin less than 10g/dL reported fatigue. Similar to observations with active vitamin D use, ESA brand share was sharply divided across the different dialysis center affiliations.
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