Tenapanor for peritoneal dialysis patients with hyperphosphatemia: a phase 3 trial

• Published in: Clinical and experimental nephrology 2024-02, Vol.28 (2), p.153-164
• Main Authors: Nakayama, Masaaki, Kobayashi, Shuhei, Kusakabe, Miho, Ohara, Meiko, Nakanishi, Kaoru, Akizawa, Tadao, Fukagawa, Masafumi
• Format: Article
• Language: English
• Subjects: Diarrhea; Humans; Hyperphosphatemia; Hyperphosphatemia - drug therapy; Hyperphosphatemia - etiology; Isoquinolines; Medicine; Medicine & Public Health; Na+/H+-exchanging ATPase; Nephrology; Oral administration; Original; Original Article; Patients; Peritoneal dialysis; Peritoneal Dialysis - adverse effects; Peritoneum; Phosphates; Phosphorus; Sulfonamides; Urology
• ISSN: 1342-1751; 1437-7799; 1437-7799
• DOI: 10.1007/s10157-023-02406-1

Background Tenapanor is a novel selective inhibitor of intestinal sodium/hydrogen exchanger 3 transporter. This is the first trial to assess the efficacy and safety of tenapanor in Japanese patients with hyperphosphatemia who are undergoing peritoneal dialysis. Methods This phase 3, open-label, multicenter, single-arm clinical trial targeted patients whose serum phosphorus was within 3.5–7.0 mg/dL with phosphate binders at screening. After phosphate binder washout, tenapanor was orally administered twice-daily, stepwise from 5 to 30 mg/dose for 16 weeks. The primary endpoint, mean change in serum phosphorus level, was evaluated at week 8. The 16-week treatment period was completed with tenapanor alone, and only one phosphate binder type was allowed for combined use after the primary endpoint. Results Of the 54 patients enrolled, 34 completed the study. At week 8, the primary endpoint, mean change in serum phosphorus level (last observation carried forward), was − 1.18 mg/dL (95% confidence interval: − 1.54, − 0.81 mg/dL) with tenapanor. From a baseline value of 7.65 mg/dL, serum phosphorus decreased to 6.14 and 5.44 mg/dL at weeks 8 and 16, respectively, and 46.3% and 76.5% of patients achieved serum phosphorus within 3.5–6.0 mg/dL at week 8 and week 16, respectively. The most common adverse event, diarrhea, occurred in 74.1% of patients; the severity of diarrhea was mild or moderate. Thus, the discontinuation percentage due to diarrhea was low at 5.6%. Conclusions Administration of tenapanor resulted in a sufficient reduction in serum phosphorus level at week 8 and was considered safe and tolerable. Trial registration NCT04766385.