Reduced-dose rasburicase (recombinant xanthine oxidase) in adult cancer patients with hyperuricemia.
Recombinant urate oxidase (rasburicase) lowers uric acid levels rapidly to very low levels at the labeled dose of 0.15-0.2 mg/kg daily for 5 days. Our past experience showed that a lower dose (3 mg) lowered uric acid levels sufficiently in most patients. A retrospective review was conducted to determine the effect of a fixed 3 mg dose of rasburicase in 43 adult patients with cancer undergoing hematopoietic stem cell transplantation or receiving chemotherapy who had elevated or rising uric acid levels (6.4-16.8 mg/dl; median 9.6). Six patients received a second dose of rasburicase (3 mg in four patients and 1.5 mg in two patients) 24 h later. Patients received allopurinol, adequate hydration, as well as other supportive therapy as required. Uric acid levels declined by 6-95% (median 43%) within the first 24 h after rasburicase administration, and levels at 48 h were 9-91% (median 65%) lower than the baseline levels. Serum creatinine changed by < or =10% in 21 patients, increased by >10% in four patients and decreased by >10% in 18 patients. No significant renal dysfunction developed in any of the patients. We conclude that rasburicase is effective in lowering uric acid levels at a fixed dose of 3 mg, which is much lower than the recommended dose.
Trifilio
S
S
Pharmacy Department, Northwestern Memorial Hospital, Chicago, IL 60611, USA.
Gordon
L
L
Singhal
S
S
Tallman
M
M
Evens
A
A
Rashid
K
K
Fishman
M
M
Masino
K
K
Pi
J
J
Mehta
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D033461:Hyperuricemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000628:therapy; D011994:Recombinant Proteins / Q000008:administration & dosage; D012189:Retrospective Studies; D015275:Tumor Lysis Syndrome / Q000097:blood / Q000150:complications / Q000188:drug therapy; D014503:Urate Oxidase / Q000008:administration & dosage*; D014527:Uric Acid / Q000097:blood
D011994:Recombinant Proteins; C469709:rasburicase; D014527:Uric Acid; D003404:Creatinine; D014503:Urate Oxidase