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Clinical insights: rethinking phosphorus management with XPHOZAH

Drs. Nelson Kopyt and William Raffo discuss their phosphorus targets and how XPHOZAH changed their approach to managing patients above goal.

Nelson Kopyt, DO, FASN, FNKF, FACP, CPI
Clinical Professor of Medicine, Morsani College of Medicine Lehigh Valley Hospital Network
William Raffo, MD
Clinical Nephrologist Medical Director, Sutter Health
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Transcript
0:25
Dr. Kopyt: What my phosphate target is, is normal, less than 4.5. Unfortunately, what's acceptable at my quality review meetings is less than 5.5, which I don't think from my perspective meets the needs of my patients. The percent of patients that in my practice, in my clinic, that do not achieve a goal of 4.5 or less is probably 85 to 90%.
0:58
Dr. Raffo: My phosphorus target is probably 4.5 to 5.5, if at all possible. I would say 50% of my patients don't achieve that target.
1:16
Dr. Kopyt: I'm a firm believer in education of my patients and I'm a firm believer in them participating in the decision making. So now I explain to them that I now have a therapy that works differently than the binders, but also actually works in concert with them to help lower the phosphorus levels so that they can understand it's a different medicine because they all know what binders are. They've been taking them for a long period of time. So, I explain to them that we now have a new therapy that works completely differently, you take it completely differently, and that with the binders unless they can't tolerate the binders and then I have a therapy that still they can use, I can now have impact on lowering their phosphorus levels.
2:03
Dr. Raffo: XPHOZAH has really been a paradigm change for me and my patients and my practice. It's felt a long time like I've just been banging my head against the wall doing the same thing and getting the same results. What I really like about XPHOZAH is it's just twice a day.
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Indication

XPHOZAH (tenapanor) 30 mg BID is indicated to reduce serum phosphorus in adults with chronic kidney disease (CKD) on dialysis as add-on therapy in patients who have an inadequate response to phosphate binders or who are intolerant of any dose of phosphate binder therapy.

Important Safety Information

Contraindications

XPHOZAH is contraindicated in:

  • Pediatric patients under 6 years of age
  • Patients with known or suspected mechanical gastrointestinal obstruction

Warnings and precautions

Diarrhea

Patients may experience severe diarrhea. Treatment with XPHOZAH should be discontinued in patients who develop severe diarrhea.

Most Common Adverse Reactions

Diarrhea, which occurred in 43-53% of patients, was the only adverse reaction reported in at least 5% of XPHOZAH-treated patients with CKD on dialysis across trials. The majority of diarrhea events in XPHOZAH-treated patients were reported to be mild-to-moderate in severity and resolved over time, or with dose reduction. Diarrhea was typically reported soon after initiation but could occur at any time during treatment with XPHOZAH. Severe diarrhea was reported in 5% of XPHOZAH-treated patients in these trials.

For additional safety information, please see full Prescribing Information.

Indication

XPHOZAH (tenapanor) 30 mg BID is indicated to reduce serum phosphorus in adults with chronic kidney disease (CKD) on dialysis as add-on therapy in patients who have an inadequate response to phosphate binders or who are intolerant of any dose of phosphate binder therapy.

Important Safety Information

Contraindications

XPHOZAH is contraindicated in:

  • Pediatric patients under 6 years of age
  • Patients with known or suspected mechanical gastrointestinal obstruction

Warnings and precautions

Diarrhea

Patients may experience severe diarrhea. Treatment with XPHOZAH should be discontinued in patients who develop severe diarrhea.

Most Common Adverse Reactions

Diarrhea, which occurred in 43-53% of patients, was the only adverse reaction reported in at least 5% of XPHOZAH-treated patients with CKD on dialysis across trials. The majority of diarrhea events in XPHOZAH-treated patients were reported to be mild-to-moderate in severity and resolved over time, or with dose reduction. Diarrhea was typically reported soon after initiation but could occur at any time during treatment with XPHOZAH. Severe diarrhea was reported in 5% of XPHOZAH-treated patients in these trials.

For additional safety information, please see full Prescribing Information.

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