In a new 2-part video interview, Professor Denis Fouque from the Université de Lyon discusses how to help patients achieve target phosphate levels during a question and an answer session. In Part 2, Professor Fouque discusses:
- Measures that can be taken to support patients with poor adherence
- Thoughts on the new phosphate binder, sucroferric oxyhydroxide, and its potential impact on adherence and pill burden
To increase compliance to the drug, there are many options. First, we have to make the patient convinced that the medication is important for his or her disease and will help him to reduce consequences of abnormal metabolic patterns. Second, the number of pills, of course, is extremely important.– Professor Denis Fouque
Based on your experience, what support is needed to help improve medication adherence?
[The] important thing [is] that chronic kidney disease is a chronic disease, which will last for many years, probably 20 to 30 years. The road is not that easy. Every year, every new step, every CKD stage, patient[s] will meet new challenges, will become a little bit sicker every year, will have more restrictions, more diet control, more pills to take, more frequent hospitalisation referrals, more frequent blood draws, etc. It is very important to help the patient to cope with their disease and the diet is a very important step. They should first meet a dietician, frequently, to help them to focus on the best food and nutrition intake during all these CKD stages.
To increase compliance to the drug, there are many options. First, we have to make the patient convinced that the medication is important for his or her disease and will help him to reduce consequences of abnormal metabolic patterns. Second, the number of pills, of course, is extremely important, because if you have to take 20 pills per day, you have to drink water. This may reduce your appetite if you take these drugs before lunch, for example.
So we really have to make the patient understand how important is to take these pills. Of course, [reducing] the number of pills is a primary goal to achieve, and reducing the pill number may help the compliance of the patients.
What is your opinion on the new iron-based phosphate binder, sucroferric oxyhydroxide?
Sucroferric oxyhydroxide, a new iron-based, calcium-free phosphate binders, may be an interesting option because it binds phosphate extremely strong[ly] throughout the entire gastrointestinal lumen. It is pH [insensitive], which means that the binding will occur all along the gastrointestinal tract. This represents an interesting option as compared to other binders. The binding of phosphate with this new iron-based binder will be definitive. This is interesting because it may not be reabsorbed further along the gastrointestinal tract. In addition, the iron will not be absorbed because of this strong phosphate binding. In recent studies, there was no need to monitor iron status because there was no difference as compared to the other tested non-iron phosphate binders. So as a consequence, this new drug may be of interest, because it will bind phosphate very strongly and in a definitive fashion along the gastrointestinal tract.
What is your opinion on the pill burden and compliance issues with regard to this new phosphate binder?
I think with sucroferric oxyhydroxide, the positive thing is that the patient can take one pill per meal, which corresponds to the protein and phosphate load. There is a kind of logic to explain to the patient that if he eats proteins and phosphate, he has to take one pill per meal. I think he may better understand the necessity to associate protein and this new binder.