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Utilization patterns and clinical outcomes of rasburicase administration according to tumor risk stratification.
- Source :
-
Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners [J Oncol Pharm Pract] 2020 Apr; Vol. 26 (3), pp. 529-535. Date of Electronic Publication: 2019 Jun 05. - Publication Year :
- 2020
-
Abstract
- Purpose: Current guidelines for tumor lysis syndrome management recommend rasburicase for high-risk patients. Adherence to guidelines has not been well studied, and the correlation between uric acid reduction and clinically relevant outcomes, such as acute kidney injury, remains unclear. Our study aims to describe rasburicase utilization patterns and outcomes in cancer patients with varying risks for tumor lysis syndrome.<br />Methods: In this retrospective cohort study, we included cancer inpatients who received rasburicase for tumor lysis syndrome management at two affiliated academic hospitals from 2009 to 2015. Patients were classified by tumor lysis syndrome risk categories prior to drug administration. Primary outcomes included acute kidney injury incidence and renal recovery. Secondary outcomes included uric acid nadir, mortality, and hospital length-of-stay.<br />Results: Among 164 patients, 42 (26%) had high-, 63 (38%) had intermediate-, and 59 (36%) had low-risk for tumor lysis syndrome. A total of 94 patients (57%) had existing renal dysfunction prior to rasburicase use. This occurred more frequently in low- (68%) compared to intermediate- (57%) and high- (43%) risk patients ( p = 0.044). A greater proportion of patients in the high-risk group (78%) had renal recovery when compared to the intermediate- (61%) or low- (45%) risk groups ( p = 0.056). Despite a similar length of stay, the high-risk group had a significantly lower 30-day mortality (10%) when compared to intermediate- (25%) or low- (32%) risk groups ( p = 0.029).<br />Conclusions: Our results suggest that rasburicase may be frequently prescribed to treat hyperuricemia unrelated to tumor lysis syndrome in cancer patients. Improved education and adherence to guidelines may improve clinical and economic outcomes associated with rasburicase administration.
- Subjects :
- Acute Kidney Injury epidemiology
Aged
Female
Gout Suppressants adverse effects
Humans
Male
Middle Aged
Neoplasms drug therapy
Retrospective Studies
Risk Assessment
Risk Factors
Uric Acid metabolism
Gout Suppressants administration & dosage
Hyperuricemia drug therapy
Tumor Lysis Syndrome drug therapy
Urate Oxidase administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1477-092X
- Volume :
- 26
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners
- Publication Type :
- Academic Journal
- Accession number :
- 31167612
- Full Text :
- https://doi.org/10.1177/1078155219851543