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Utilization patterns and clinical outcomes of rasburicase administration according to tumor risk stratification.
J Oncol Pharm Pract 2019; :1078155219851543JO

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.

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.

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).

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.

Authors+Show Affiliations

1 Case Western Reserve University School of Medicine, Cleveland, OH, USA.2 Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.2 Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.3 Pharmacy Services, University of Washington Medical Center, Seattle, WA, USA.4 Fred Hutchinson Cancer Research Center, Seattle, WA, USA.3 Pharmacy Services, University of Washington Medical Center, Seattle, WA, USA.5 Division of Hematology, University of Washington School of Medicine, Seattle, WA, USA.5 Division of Hematology, University of Washington School of Medicine, Seattle, WA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31167612

Citation

Khalighi, Parisa R., et al. "Utilization Patterns and Clinical Outcomes of Rasburicase Administration According to Tumor Risk Stratification." Journal of Oncology Pharmacy Practice : Official Publication of the International Society of Oncology Pharmacy Practitioners, 2019, p. 1078155219851543.
Khalighi PR, Martens KL, White AA, et al. Utilization patterns and clinical outcomes of rasburicase administration according to tumor risk stratification. J Oncol Pharm Pract. 2019.
Khalighi, P. R., Martens, K. L., White, A. A., Li, S., Silgard, E., Frieze, D., ... Li, A. (2019). Utilization patterns and clinical outcomes of rasburicase administration according to tumor risk stratification. Journal of Oncology Pharmacy Practice : Official Publication of the International Society of Oncology Pharmacy Practitioners, p. 1078155219851543. doi:10.1177/1078155219851543.
Khalighi PR, et al. Utilization Patterns and Clinical Outcomes of Rasburicase Administration According to Tumor Risk Stratification. J Oncol Pharm Pract. 2019 Jun 5;1078155219851543. PubMed PMID: 31167612.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Utilization patterns and clinical outcomes of rasburicase administration according to tumor risk stratification. AU - Khalighi,Parisa R, AU - Martens,Kylee L, AU - White,Andrew A, AU - Li,Shan, AU - Silgard,Emily, AU - Frieze,Deborah, AU - Garcia,David A, AU - Li,Ang, Y1 - 2019/06/05/ PY - 2019/6/7/entrez PY - 2019/6/7/pubmed PY - 2019/6/7/medline KW - Acute kidney injury KW - hyperuricemia KW - rasburicase KW - tumor lysis syndrome SP - 1078155219851543 EP - 1078155219851543 JF - Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners JO - J Oncol Pharm Pract N2 - 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. 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. 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). 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. SN - 1477-092X UR - https://www.unboundmedicine.com/medline/citation/31167612/Utilization_patterns_and_clinical_outcomes_of_rasburicase_administration_according_to_tumor_risk_stratification L2 - http://journals.sagepub.com/doi/full/10.1177/1078155219851543?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -