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

Sooyoung Shin, Sukhyang LeeAjou 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 t...

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Autores principales:	Shin S, Lee S
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/6d9427cb8ec646d2955c082f3859ba55
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spelling	oai:doaj.org-article:6d9427cb8ec646d2955c082f3859ba552021-12-02T12:24:04ZNiacin as a drug repositioning candidate for hyperphosphatemia management in dialysis patients1178-203Xhttps://doaj.org/article/6d9427cb8ec646d2955c082f3859ba552014-10-01T00:00:00Zhttp://www.dovepress.com/niacin-as-a-drug-repositioning-candidate-for-hyperphosphatemia-managem-peer-reviewed-article-TCRMhttps://doaj.org/toc/1178-203X Sooyoung Shin, Sukhyang LeeAjou 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.Keywords: niacin, nicotinic acid, nicotinamide, niacinamide, hyperphosphatemia, dialysisShin SLee SDove Medical PressarticleTherapeutics. PharmacologyRM1-950ENTherapeutics and Clinical Risk Management, Vol 2014, Iss default, Pp 875-883 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Therapeutics. Pharmacology RM1-950
spellingShingle	Therapeutics. Pharmacology RM1-950 Shin S Lee S Niacin as a drug repositioning candidate for hyperphosphatemia management in dialysis patients
description	Sooyoung Shin, Sukhyang LeeAjou 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.Keywords: niacin, nicotinic acid, nicotinamide, niacinamide, hyperphosphatemia, dialysis
format	article
author	Shin S Lee S
author_facet	Shin S Lee S
author_sort	Shin S
title	Niacin as a drug repositioning candidate for hyperphosphatemia management in dialysis patients
title_short	Niacin as a drug repositioning candidate for hyperphosphatemia management in dialysis patients
title_full	Niacin as a drug repositioning candidate for hyperphosphatemia management in dialysis patients
title_fullStr	Niacin as a drug repositioning candidate for hyperphosphatemia management in dialysis patients
title_full_unstemmed	Niacin as a drug repositioning candidate for hyperphosphatemia management in dialysis patients
title_sort	niacin as a drug repositioning candidate for hyperphosphatemia management in dialysis patients
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/6d9427cb8ec646d2955c082f3859ba55
work_keys_str_mv	AT shins niacinasadrugrepositioningcandidateforhyperphosphatemiamanagementindialysispatients AT lees niacinasadrugrepositioningcandidateforhyperphosphatemiamanagementindialysispatients
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Niacin as a drug repositioning candidate for hyperphosphatemia management in dialysis patients

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