Lanthanum Associated With Lower Cardiovascular Risk Than Sevelamer in Dialysis Cohort

Comparative clinical outcome evidence for non–calcium-based phosphate binders remains limited. Researchers used the China Renal Data System to emulate a target trial comparing lanthanum carbonate with sevelamer initiation in patients receiving dialysis with hyperphosphatemia and no documented prior major adverse cardiovascular events (MACE). The active-comparator, new-user study included 10,518 propensity-matched patients, with 5,259 per group. The primary endpoint was myocardial infarction, stroke, or cardiovascular death.

Over three years, 280 MACE events occurred in the lanthanum group versus 325 in the sevelamer group. Estimated cumulative incidence was 9.5% versus 12.2%, respectively (HR, 0.79; 95% CI, 0.68–0.92). The authors reported an absolute risk reduction of 2.68 percentage points and a number needed to treat of 37. Lanthanum initiation was also associated with lower all-cause mortality (HR, 0.83; 95% CI, 0.75–0.93) and cardiovascular mortality (HR, 0.72; 95% CI, 0.59–0.88).

Findings were consistent across sensitivity and subgroup analyses, and the MACE association remained significant in competing-risk analyses. These results may inform comparative assessment of phosphate binders, but propensity matching cannot eliminate residual confounding. The reported number needed to treat should therefore not be interpreted as a proven treatment benefit. Applicability to patients with prior MACE remains uncertain.