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Hill Gallant KM, Stremke ER, Trevino LL, Moorthi RN, Doshi S, Wastney ME, Hisada N, Sato J, Ogita Y, Fujii N, Matsuda Y, Kake T, Moe SM. EOS789, a broad-spectrum inhibitor of phosphate transport, is safe with an indication of efficacy in a phase 1b randomized crossover trial in hemodialysis patients. Kidney Int 2020; 99:1225-1233. [PMID: 33137340 DOI: 10.1016/j.kint.2020.09.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 09/11/2020] [Accepted: 09/17/2020] [Indexed: 12/17/2022]
Abstract
The treatment of hyperphosphatemia remains challenging in patients receiving hemodialysis. This phase 1b study assessed safety and efficacy of EOS789, a novel pan-inhibitor of phosphate transport (NaPi-2b, PiT-1, PiT-2) on intestinal phosphate absorption in patients receiving intermittent hemodialysis therapy. Two cross-over, randomized order studies of identical design (ten patients each) compared daily EOS789 50 mg to placebo with meals and daily EOS789 100 mg vs EOS789 100 mg plus 1600 mg sevelamer with meals. Patients ate a controlled diet of 900 mg phosphate daily for two weeks and began EOS789 on day four. On day ten, a phosphate absorption testing protocol was performed during the intradialytic period. Intestinal fractional phosphate absorption was determined by kinetic modeling of serum data following oral and intravenous doses of 33Phosphate (33P). The results demonstrated no study drug related serious adverse events. Fractional phosphate absorption was 0.53 (95% confidence interval: 0.39,0.67) for placebo vs. 0.49 (0.35,0.63) for 50 mg EOS789; and 0.40 (0.29,0.50) for 100 mg EOS789 vs. 0.36 (0.26,0.47) for 100 mg EOS789 plus 1600 mg sevelamer (all not significantly different). The fractional phosphate absorption trended lower in six patients who completed both studies with EOS789 100 mg compared with placebo. Thus, in this phase 1b study, EOS789 was safe and well tolerated. Importantly, the use of 33P as a sensitive and direct measure of intestinal phosphate absorption allows specific testing of drug efficacy. The effectiveness of EOS789 needs to be evaluated in future phase 2 and phase 3 studies.
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Affiliation(s)
- Kathleen M Hill Gallant
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA; Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Elizabeth R Stremke
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
| | - Laurie L Trevino
- Clinical Translational Sciences Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ranjani N Moorthi
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Simit Doshi
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Meryl E Wastney
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA; Metabolic Modeling Services, West Lafayette, Indiana, USA
| | | | | | | | | | | | | | - Sharon M Moe
- Clinical Translational Sciences Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA; Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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Bicarbonate : de la physiologie aux applications thérapeutiques pour tout clinicien. Nephrol Ther 2018; 14:13-23. [DOI: 10.1016/j.nephro.2017.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 02/22/2017] [Indexed: 11/17/2022]
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