Therapeutic effectiveness and safety profile of lanthanum carbonate in conjunction with calcium carbonate for managing hyperphosphatemia in hemodialysis patients: a meta-analysis of randomized controlled trials

Abstract

Objective: To comprehensively investigate the efficacy and safety of lanthanum carbonate in conjugation with calcium carbonate combination in hemodialysis patients with hyperphosphatemia via a meta-analysis of randomized controlled trials (RCTs).

Method: We conducted a literature search in databases of PubMed, Embase, and Web of Science for RCTs investigating the effect of lanthanum carbonate in combination with calcium carbonate for treating hyperphosphatemia in hemodialysis patients. The search covered all studies from the inception of the database until October 2023. Data extraction and quality assessment were performed on eligible studies, followed by a meta-analysis using RevMan5.3 software.

Results: Ten studies fulfilling the inclusion criteria were included, with a sample size of 475 patients (256 in the experimental group who received lanthanum carbonate and calcium carbonate; 219 in the control group who received calcium carbonate alone). The experimental group showed a significantly higher clinical response rate compared to the control group [Relative Risk (RR) = 1.21, 95% CI = (1.12, 1.30), P < 0.01]. Moreover, the serum phosphorus levels [MD = -0.34, 95% CI = (-0.39, -0.29), P < 0.01], serum calcium levels [MD = -0.09, 95% CI = (-0.14, -0.05), P < 0.01], serum intact parathyroid hormone (iPTH) levels [MD = -35.05, 95% CI = (-45.31, -24.796), P < 0.01], and the incidence of adverse reactions [RR = 1.22, 95% CI = (1.08, 1.39), P < 0.01] were all lower in the experimental group compared to those in the control group. The funnel plot exhibited symmetrical distribution, and Egger's and Begg's tests did not reveal any evidence of significant publication bias (all P > 0.05).

Conclusions: The combined use of lanthanum carbonate and calcium carbonate demonstrates a superior clinical efficacy in the management of hyperphosphatemia in hemodialysis patients, as compared to the use of calcium carbonate as a standalone treatment. To corroborate these findings, it is essential to conduct additional multi-center, RCTs with substantial sample sizes.

Keywords: Lanthanum carbonate; calcium carbonate; clinical effective rate; hemodialysis; hyperphosphatemia.