The value of fixed rasburicase dosing versus weight-based dosing in the treatment and prevention of tumor lysis syndrome

Abstract

Background Rasburicase is a recombinant urate oxidase enzyme used for the treatment and prevention of tumor lysis syndrome. Our objective was to assess the efficacy of indication-based, low-dose rasburicase administration compared to the Food and Drug Administration-approved weight-based dosing. Methods This was a retrospective cohort study utilizing data from a tertiary medical center including patients admitted from 2012 to 2016, who received at least one dose of rasburicase. The primary outcome was achieving a uric acid level less than 7.5 mg/dl after a single dose of rasburicase in the preprotocol (Food and Drug Administration-approved weight-based dosing) and postprotocol (indication-based, low-dose) groups. Secondary outcomes included the change in uric acid levels between the pre- and postprotocol groups, adherence to the new institutional protocol, need for repeat rasburicase doses, and a cost analysis. Results Sixty-four patients received at least one dose of rasburicase between 1 January 2012 and 1 December 2016. Twenty-seven (79.4%) doses in the preprotocol group and 28 (82.4%) doses in the postprotocol group successfully achieved a uric acid level less than 7.5 mg/dl after a single dose of rasburicase (p=1.000). The average total monthly cost of rasburicase was reduced by 59.9% after adoption of the new protocol. Conclusions Indication-based, low-dose rasburicase displayed significantly more value when compared to weight-based dosing as shown by achieving cost savings without compromising clinical efficacy.

Rasburicase dose optimization for tumor lysis syndrome management in a network of community oncology practices

“…Multiple retrospective chart reviews and meta-analyses have demonstrated the clinical and financial effectiveness of single fixed-dose rasburicase in the treatment and prevention of hyperuricemia or TLS in tertiary academic centers. 2–4,9–16 Our study is the first, to our knowledge, to publish real word data of rasburicase utilization and the efficacy of single fixed doses (3 or 6 mg) within a large network of community oncology practices. American Society of Clinical Oncology (ASCO) guidelines recommend rasburicase for patients with intermediate risk of TLS if hyperuricemia develops, and National Comprehensive Cancer Network (NCCN) guidelines for B-cell lymphomas recommend to consider TLS prophylaxis for Burkitt’s lymphoma, lymphoblastic lymphoma, and occasionally diffuse large b-cell lymphoma (DLBCL).…”

Rasburicase versus intravenous allopurinol for non-malignancy-associated acute hyperuricemia in paediatric cardiology patients

“…It is approved for treatment of tumour lysis syndrome as a weight-based dose daily for 5 days, 9 although single and fixed-dose regimens have been reported to be effective in lowering uric acid levels. 10,11 Allopurinol, available in both enteral and parenteral forms, is an inhibitor of xanthine oxidase, which blocks further synthesis of uric acid from urate. However, allopurinol does not affect existing serum uric acid levels and thus may require a longer treatment course.…”