Rasburicasa versus alopurinol como tratamiento de la hiperuricemia en el síndrome de lisis tumoral

Rasburicase in the management of tumor lysis: an evidence-based review of its place in therapy

“… 35 None of the seven studies reported the incidence of LTLS. Pooled results of the five CCTs 23 – 25 , 34 , 35 showed a significantly lower frequency of renal failure requiring RRT in participants who received urate oxidase compared with those who received allopurinol. This may be considered level 3 evidence in the pediatric population, keeping in mind that some of the studies included used Uricozyme, and others rasburicase.…”

“…However, in the pediatric population, the Cochrane database systematic review 17 found not only a higher frequency of PUA normalization at 4 hours and a significantly lower AUC of PUA at 4 days in the rasburicase group of the RCT, 18 but also significantly lower PUA levels in patients receiving nonrecombinant urate oxidase or rasburicase at 2, 3, 4, and 7 days based on three controlled clinical trials (CCTs). 23 – 25 …”

“… 16 The other was included because it had a similar design (same chemotherapy backbone, similar patient population) to another study that used allopurinol, so provided a reasonable comparison of rasburicase with allopurinol in terms of reducing the incidence of LTLS, CTLS, and need for continuous venovenous hemofiltration. 25 These studies were relatively inconsistent in their results, which was largely due to differences in study design as well as power issues. Additionally, there was a high level of bias in all studies.…”

“… 16 Among the seven studies included in the Cochrane review, the only RCT that compared allopurinol with rasburicase was the pivotal trial reported by Goldman et al 18 The other six studies included were an RCT that compared different doses of rasburicase 33 and five CCTs that mostly used historical controls. 23 – 25 , 34 , 35 Three of the latter did not use rasburicase, but rather Uricozyme ® (nonrecombinant urate oxidase). 24 , 34 , 35 All seven were TLS prevention rather than treatment trials.…”

“… 18 In the Cochrane database systematic review of the pediatric literature, 17 pooled results from three CCTs 23 , 25 , 35 showed no significant difference in all-cause mortality between the urate oxidase and control groups. However, pooled results of three CCTs 23 , 25 , 34 showed a significantly lower mortality due to TLS in the group that received Uricozyme or rasburicase compared with the group that received allopurinol, 17 which could be interpreted as level 3 evidence in favor of urate oxidase in children. Lopez-Olivo et al attempted to perform a meta-analysis evaluating mortality among other outcomes, but due to intertrial heterogeneity in terms of outcomes reported, were unable to do so.…”