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Rasburicase in Tumor Lysis Syndrome of the Adult: A Systematic Review and Meta-analysis
Published Web Locationhttps://doi.org/10.1053/j.ajkd.2013.02.378
BackgroundThe use of rasburicase has been evaluated extensively in children, but not in adults. We review the current literature to evaluate its effect on adults.
Study designSystematic review and meta-analysis.
Setting & populationAdults receiving rasburicase for tumor lysis syndrome (TLS).
Selection criteria for studiesElectronic databases, regulatory documents, and websites were searched up to August 7, 2012. Reference lists of published articles were examined for additional relevant references. Any controlled trial or observational studies (controlled before and after) were included. Studies considering children only or mixing data for children and adults were excluded.
InterventionRasburicase for TLS.
OutcomesThe primary outcome was TLS development. Secondary outcomes included percentage of patients improving, total adverse events, acute kidney failure, deaths, and serum uric acid and creatinine levels.
Results21 studies (24 publications) reported data for 1,261 adult patients, 768 receiving rasburicase for either the treatment or prophylaxis of TLS; these comprised 4 controlled trials and 17 observational studies. No statistically significant differences in clinical TLS development were observed in the controlled trials between the rasburicase and control groups. For the observational studies, 7.4% of patients developed clinical TLS after rasburicase (95% CI, 1.7%-16.7%), 93.4% of patients achieved normalized serum uric acid levels after rasburicase treatment (95% CI, 91.7%-94.6%), 4.4% developed acute kidney injury (95% CI, 3.0%-6.0%), and 2.6% died (95% CI, 0.95%-5.0%). The mean reduction in serum uric acid levels ranged from 5.3-12.8 mg/dL, and for serum creatinine levels, from 0.10-2.1 mg/dL.
LimitationsControlled trials differed in outcomes reported; meta-analysis was not performed.
ConclusionsRasburicase is effective in reducing serum uric acid levels in adults with TLS but at a significant cost, and evidence currently is lacking in adults to report whether rasburicase use improves clinical outcomes compared with other alternatives. Until new evidence is available, use of rasburicase may be limited to adult patients with a high risk of TLS.
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