Rasburicase More Effective Than Allopurinol for Tumor Lysis Syndrome

In patients with tumor lysis syndrome, rasburicase was significantly more effective in treating hyperuricemia and was associated with significantly shorter ICU stay.
In patients with tumor lysis syndrome, rasburicase was significantly more effective in treating hyperuricemia and was associated with significantly shorter ICU stay.

In patients with tumor lysis syndrome, rasburicase was significantly more effective in treating hyperuricemia and was associated with significantly shorter ICU stay and overall hospitalization, according to a study published in the journal Clinical Lymphoma, Myeloma & Leukemia.1

Hypouricemic agents such as allopurinol and rasburicase are used in the prevention of tumor lysis syndrome in patients with cancer. One agent may be preferred over another in certain settings, but may sometimes be used interchangeably in select patients.

To compare reductions in uric acid, lengths of stay, and hospitalization costs in patients with tumor lysis syndrome treated with rasburicase or allopurinol, researchers retrospectively analyzed data from 26 rasburicase-treated patients and 104 matched allopurinol-treated patients.

Results showed that rasburicase was significantly associated with a reduction in plasma uric acid levels of 5.3 mg/dL greater than that of allopurinol (P <.0001).

Researchers also found that patients treated with rasburicase had a 2.5-day shorter stay in the ICU (P <.0001) and a 5-day shorter overall length of hospitalization (P =.02) vs those given allopurinol.

In terms of cost, the study showed that total inpatient costs were significantly lower with rasburicase. Total costs per patient were $20,038 lower for rasburicase (P <.02) and researchers determined that the cost per percentage of uric acid reduction was $3,899 with rasburicase vs $16,894 with allopurinol (P <.001).

Although these findings demonstrate that rasburicase may be more cost-effective and clinically effective for reducing hospitalization compared with allopurinol, current guidelines recommend rasburicase in high-risk patients and allopruinol in intermediate-risk patients.

Reference

1. Cairo MS, Thompson S, Tangirala K, Eaddy MT. A clinical and economic comparison of rasburicase and allopurinol in the treatment of patients with clinical or laboratory tumor lysis syndrome. Clin Lymphoma Myeloma Leuk. 2016 Nov 21. doi: 10.1016/j.clml.2016.11.003. In press.
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