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

Shin S, Lee S - Ther Clin Risk Manag (2014)

Bottom Line: Additive beneficial effects on lipid parameters were also observed.Sevelamer appeared superior to niacin in a comparative study, but the study design had several limitations.Niacin can be a patient-convenient and inexpensive alternative or adjunctive therapy for phosphorus management in dialysis patients.

View Article: PubMed Central - PubMed

Affiliation: Ajou University College of Pharmacy, Yeongtong-gu, Suwon-si, Gyeonggi-do, Korea.

ABSTRACT
Nearly all patients with end-stage renal disease develop hyperphosphatemia. These patients typically require oral phosphate binders for life-long phosphorus management, in addition to dietary restrictions and maintenance dialysis. Recently, niacin, a traditional antilipemic agent, drew attention as an experimental treatment for hyperphosphatemia. The purpose of this article was to report on new findings regarding niacin's novel effects and to review the possibility of repurposing niacin for hyperphosphatemia treatment in dialysis patients by elucidating its safety and efficacy profiles along with its synergistic clinical benefits. Following approval from the Institutional Review Board, we tracked the yearly trends of order frequency of niacin in comparison with statins and sevelamer in a tertiary care hospital. Also, a Cochrane Library and PubMed literature search was performed to capture prospective clinical trials on niacin's hypophosphatemic effects in dialysis patients. Niacin use in clinical settings has been on the wane, and the major contribution to that originates from the wide use of statins. Niacin use rates have further plummeted following a trial failure which prompted the suspension of the niacin-laropiprant (a flushing blocker) combination product in the global market. Our literature search identified ten relevant articles. Overall, all studies demonstrated that niacin or nicotinamide (the metabolite form) reduced serum phosphorus levels as well as Ca-P products significantly. Additive beneficial effects on lipid parameters were also observed. Sevelamer appeared superior to niacin in a comparative study, but the study design had several limitations. The intervention dosage for niacin ranged from 375 to 1,500 mg/day, with the average daily dose of approximately 1,000-1,500 mg. Niacin can be a patient-convenient and inexpensive alternative or adjunctive therapy for phosphorus management in dialysis patients. Further well-designed, large-scale, long-term, comparative trials are needed to successfully repurpose niacin for the new indication.

No MeSH data available.


Related in: MedlinePlus

Order frequency of niacin versus sevelamer in a single tertiary-care institution.
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f2-tcrm-10-875: Order frequency of niacin versus sevelamer in a single tertiary-care institution.

Mentions: The major contribution to the usage drop originates from the rise of statins, which include the blockbuster cholesterol-lowering medications, such as atorvastatin and rosuvastatin. As an example, the yearly trends of order frequency of niacin versus statins in a tertiary-care hospital with over 1,000 patient-beds in Korea are presented in Figure 1. Niacin use rates were constantly minimal and have plummeted into near nonexistence since 2012. Conversely, statin use rates, especially atorvastatin and rosuvastatin, have skyrocketed over the past 15 years. Additionally, Figure 2 demonstrates the yearly order patterns of niacin versus sevelamer, the phosphate binder with the most favorable safety profile. The current order patterns clearly show that designing a comparative study between niacin and sevelamer retrospectively is not plausible.


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

Shin S, Lee S - Ther Clin Risk Manag (2014)

Order frequency of niacin versus sevelamer in a single tertiary-care institution.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4206247&req=5

f2-tcrm-10-875: Order frequency of niacin versus sevelamer in a single tertiary-care institution.
Mentions: The major contribution to the usage drop originates from the rise of statins, which include the blockbuster cholesterol-lowering medications, such as atorvastatin and rosuvastatin. As an example, the yearly trends of order frequency of niacin versus statins in a tertiary-care hospital with over 1,000 patient-beds in Korea are presented in Figure 1. Niacin use rates were constantly minimal and have plummeted into near nonexistence since 2012. Conversely, statin use rates, especially atorvastatin and rosuvastatin, have skyrocketed over the past 15 years. Additionally, Figure 2 demonstrates the yearly order patterns of niacin versus sevelamer, the phosphate binder with the most favorable safety profile. The current order patterns clearly show that designing a comparative study between niacin and sevelamer retrospectively is not plausible.

Bottom Line: Additive beneficial effects on lipid parameters were also observed.Sevelamer appeared superior to niacin in a comparative study, but the study design had several limitations.Niacin can be a patient-convenient and inexpensive alternative or adjunctive therapy for phosphorus management in dialysis patients.

View Article: PubMed Central - PubMed

Affiliation: Ajou University College of Pharmacy, Yeongtong-gu, Suwon-si, Gyeonggi-do, Korea.

ABSTRACT
Nearly all patients with end-stage renal disease develop hyperphosphatemia. These patients typically require oral phosphate binders for life-long phosphorus management, in addition to dietary restrictions and maintenance dialysis. Recently, niacin, a traditional antilipemic agent, drew attention as an experimental treatment for hyperphosphatemia. The purpose of this article was to report on new findings regarding niacin's novel effects and to review the possibility of repurposing niacin for hyperphosphatemia treatment in dialysis patients by elucidating its safety and efficacy profiles along with its synergistic clinical benefits. Following approval from the Institutional Review Board, we tracked the yearly trends of order frequency of niacin in comparison with statins and sevelamer in a tertiary care hospital. Also, a Cochrane Library and PubMed literature search was performed to capture prospective clinical trials on niacin's hypophosphatemic effects in dialysis patients. Niacin use in clinical settings has been on the wane, and the major contribution to that originates from the wide use of statins. Niacin use rates have further plummeted following a trial failure which prompted the suspension of the niacin-laropiprant (a flushing blocker) combination product in the global market. Our literature search identified ten relevant articles. Overall, all studies demonstrated that niacin or nicotinamide (the metabolite form) reduced serum phosphorus levels as well as Ca-P products significantly. Additive beneficial effects on lipid parameters were also observed. Sevelamer appeared superior to niacin in a comparative study, but the study design had several limitations. The intervention dosage for niacin ranged from 375 to 1,500 mg/day, with the average daily dose of approximately 1,000-1,500 mg. Niacin can be a patient-convenient and inexpensive alternative or adjunctive therapy for phosphorus management in dialysis patients. Further well-designed, large-scale, long-term, comparative trials are needed to successfully repurpose niacin for the new indication.

No MeSH data available.


Related in: MedlinePlus