Rasburicase use for tumour lysis syndrome management needs improvement

Use of rasburicase for the management of patients with tumour lysis syndrome in inpatient and outpatient settings may still be improved, suggests a study.

Researchers conducted this observational, single-centre, nonrandomized, retrospective chart review between September 2018 and August 2019 to assess the utilization of rasburicase and appropriateness for the management of tumour lysis syndrome in paediatric and adult patients at the Wake Forest Baptist Health tumour lysis syndrome pocket card. The study also evaluated response to prophylactic and treatment doses of rasburicase and quantified cost vs expense of the study drug.

Fifty-seven adult and seven paediatric patients were included in the study. Rasburicase use adherence to the pocket card was 64 percent. Appropriate fluids and/or allopurinol were initiated in 34 percent of patients. Eighty percent of patients had all necessary laboratory values obtained after rasburicase administration for monitoring, while 11 (17 percent) who received treatment in the outpatient setting did not have follow-up labs collected.

Of those whose laboratory values were collected, 39 percent were appropriately timed to accurately assess efficacy, with a median time of laboratory monitoring after rasburicase of 6.5 hours. Response was noted with rasburicase 3 mg (92 percent), 6 mg (100 percent), and weight-based dosing (100 percent).

For each patient, the wholesale acquisition cost was $5,203 ($1,101–10,406). Potential cost savings with the use of 3- vs 6-mg dose for patients who did not meet the tumour lysis syndrome treatment recommendations based on the pocket card was estimated at $36,419.46.

“There are several opportunities for improvement in tumour lysis syndrome management and rasburicase utilization at our institution,” researchers said. “This study will lead to the implementation of formal restrictions for rasburicase use and selection of rasburicase dose.”