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- Title
Effectiveness of a Single 6-mg Fixed Dose of Rasburicase for Prevention or Management of Hyperuricemia Associated with Tumor Lysis Syndrome in Adults with Cancer.
- Authors
Khan, Mansoor Ahmed; Alshamrani, Majed A.; Aseeri, Mohammed A.; Al Saeed, Ahmad S.; Alhamdan, Hani S.; Masari, Ahlam O.
- Abstract
BACKGROUND: Tumor lysis syndrome (TLS) is one of the lethal complications of hematologic malignancies and some solid tumors. Hyperuricemia associated with TLS can be prevented and treated by using the drug rasburicase. As of now, the optimal rasburicase dose for adult patients has not been determined. OBJECTIVE: To evaluate the effectiveness of a single 6-mg fixed dose of rasburicase in the normalization of serum uric acid levels for 96 hours in adults with cancer. METHODS: This retrospective single-center study used the electronic medical records (EMR) of eligible patients who received rasburicase at the Princess Noorah Oncology Center between January 2008 and December 2012. Patients aged >14 years who received a single 6-mg fixed dose of rasburicase and had serum uric acid levels measured before and after treatment available in the EMR system were included in this analysis. The primary outcome measure was reductions in serum uric acid levels. The secondary outcome measures were reduction in serum uric acid levels to <7 mg/dL at 24 hours and 48 hours after the rasburicase dose and normalization of serum creatinine to <1.5 mg/dL at 96 hours, and to determine the number of rasburicase doses needed to reach these reduction levels. We also calculated the cost-savings when using a single fixed dose versus multiple doses of rasburicase. RESULTS: A total of 94 adult patients met the inclusion criteria during the 5-year study period. The patients' mean age was 44 years, with 69% (67) men and 31% (27) women. Overall, 79% (75) of the patients had a hematologic cancer diagnosis, and 21% (20) patients had a diagnosis of a malignant solid tumor. After receiving the single rasburicase dose, 79% (75) of the patients had normalization of serum uric acid (ie, <7 mg/dL; median, 1.00 mg/dL) at 24 hours, and approximately 81% (77) patients had normalized levels (median, 1.96 mg/dL) at 48 hours. Moreover, the normal uric acid levels (median, 2.97 mg/dL) were maintained for 96 hours. Normalization of serum creatinine levels (<1.5 mg/dL; median, 0.62 mg/dL) was achieved in 70% (66) of the patients at 96 hours. Overall, 78% (73) of the patients required a single 6-mg fixed dose of rasburicase, and 22% (21) required more than 1 dose of rasburicase. CONCLUSION: Our findings demonstrate that a single 6-mg fixed dose of rasburicase was effective in lowering uric acid and is as effective as weight-based rasburicase doses for multiple days. Based on these data, we recommend using the single 6-mg fixed-dose strategy for prevention or management of hyperuricemia in patients at high risk for TLS in our institution and in other cancer institutions.
- Publication
Journal of Hematology Oncology Pharmacy, 2019, Vol 9, Issue 1, p30
- ISSN
2164-1153
- Publication type
Academic Journal