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Rasburicase versus intravenous allopurinol for non-malignancy-associated acute hyperuricemia in paediatric cardiology patients.
Cardiol Young 2019; 29(9):1160-1164CY

Abstract

OBJECTIVES

Limited data exist for management of hyperuricemia in non-oncologic patients, particularly in paediatric cardiac patients. Hyperuricemia is a risk factor for acute kidney injury and may prompt treatment in critically ill patients. The primary objective was to determine if rasburicase use was associated with greater probability normalisation of serum uric acid compared to allopurinol. Secondary outcomes included percent reduction in uric acid, changes in serum creatinine, and cost of therapy.

DESIGN

A single-centre retrospective chart review.

SETTING

A 20-bed quaternary cardiovascular ICU in a university-based paediatric hospital in California.

PATIENTS

Patients admitted to cardiovascular ICU who received rasburicase or intravenous allopurinol between 2015 and 2016.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Data from a cohort of 14 patients receiving rasburicase were compared to 7 patients receiving IV allopurinol. Patients who were administered rasburicase for hyperuricemia were more likely to have a post-treatment uric acid level less than 8 mg/dl as compared to IV allopurinol (100 versus 43%; p = 0.0058). Patients who received rasburicase had a greater absolute reduction in post-treatment day 1 uric acid (-9 mg/dl versus -1.9 mg/dl; p = 0.002). There were no differences in post-treatment day 3 or day 7 serum creatinine or time to normalisation of serum creatinine. The cost of therapy normalised to a 20 kg patient was greater in the allopurinol group ($18,720 versus $1928; p = 0.001).

CONCLUSION

In a limited paediatric cardiac cohort, the use of rasburicase was associated with a greater reduction in uric acid levels and associated with a lower cost compared to IV allopurinol.

Authors+Show Affiliations

Department of Pharmacy, Lucile Packard Children's Hospital Stanford, Palo Alto, USA.Department of Pharmacy, Lucile Packard Children's Hospital Stanford, Palo Alto, USA.Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, USA.Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31451121

Citation

Moss, Jeffrey D., et al. "Rasburicase Versus Intravenous Allopurinol for Non-malignancy-associated Acute Hyperuricemia in Paediatric Cardiology Patients." Cardiology in the Young, vol. 29, no. 9, 2019, pp. 1160-1164.
Moss JD, Wu M, Axelrod DM, et al. Rasburicase versus intravenous allopurinol for non-malignancy-associated acute hyperuricemia in paediatric cardiology patients. Cardiol Young. 2019;29(9):1160-1164.
Moss, J. D., Wu, M., Axelrod, D. M., & Kwiatkowski, D. M. (2019). Rasburicase versus intravenous allopurinol for non-malignancy-associated acute hyperuricemia in paediatric cardiology patients. Cardiology in the Young, 29(9), pp. 1160-1164. doi:10.1017/S1047951119001653.
Moss JD, et al. Rasburicase Versus Intravenous Allopurinol for Non-malignancy-associated Acute Hyperuricemia in Paediatric Cardiology Patients. Cardiol Young. 2019;29(9):1160-1164. PubMed PMID: 31451121.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rasburicase versus intravenous allopurinol for non-malignancy-associated acute hyperuricemia in paediatric cardiology patients. AU - Moss,Jeffrey D, AU - Wu,May, AU - Axelrod,David M, AU - Kwiatkowski,David M, PY - 2019/8/28/pubmed PY - 2019/8/28/medline PY - 2019/8/28/entrez KW - Rasburicase KW - allopurinol KW - cardiology KW - hyperuricemia KW - paediatrics KW - uric acid SP - 1160 EP - 1164 JF - Cardiology in the young JO - Cardiol Young VL - 29 IS - 9 N2 - OBJECTIVES: Limited data exist for management of hyperuricemia in non-oncologic patients, particularly in paediatric cardiac patients. Hyperuricemia is a risk factor for acute kidney injury and may prompt treatment in critically ill patients. The primary objective was to determine if rasburicase use was associated with greater probability normalisation of serum uric acid compared to allopurinol. Secondary outcomes included percent reduction in uric acid, changes in serum creatinine, and cost of therapy. DESIGN: A single-centre retrospective chart review. SETTING: A 20-bed quaternary cardiovascular ICU in a university-based paediatric hospital in California. PATIENTS: Patients admitted to cardiovascular ICU who received rasburicase or intravenous allopurinol between 2015 and 2016. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data from a cohort of 14 patients receiving rasburicase were compared to 7 patients receiving IV allopurinol. Patients who were administered rasburicase for hyperuricemia were more likely to have a post-treatment uric acid level less than 8 mg/dl as compared to IV allopurinol (100 versus 43%; p = 0.0058). Patients who received rasburicase had a greater absolute reduction in post-treatment day 1 uric acid (-9 mg/dl versus -1.9 mg/dl; p = 0.002). There were no differences in post-treatment day 3 or day 7 serum creatinine or time to normalisation of serum creatinine. The cost of therapy normalised to a 20 kg patient was greater in the allopurinol group ($18,720 versus $1928; p = 0.001). CONCLUSION: In a limited paediatric cardiac cohort, the use of rasburicase was associated with a greater reduction in uric acid levels and associated with a lower cost compared to IV allopurinol. SN - 1467-1107 UR - https://www.unboundmedicine.com/medline/citation/31451121/Rasburicase_versus_intravenous_allopurinol_for_non-malignancy-associated_acute_hyperuricemia_in_paediatric_cardiology_patients L2 - https://www.cambridge.org/core/product/identifier/S1047951119001653/type/journal_article DB - PRIME DP - Unbound Medicine ER -