title: Reduced-dose rasburicase (recombinant xanthine oxidase) in adult cancer patients with hyperuricemia.
abstract: 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.
authors.affiliation: Pharmacy Department, Northwestern Memorial Hospital, Chicago, IL 60611, USA.
authors.forename: S
authors.initials: S
authors.lastname: Trifilio
authors.forename: L
authors.initials: L
authors.lastname: Gordon
authors.forename: S
authors.initials: S
authors.lastname: Singhal
authors.forename: M
authors.initials: M
authors.lastname: Tallman
authors.forename: A
authors.initials: A
authors.lastname: Evens
authors.forename: K
authors.initials: K
authors.lastname: Rashid
authors.forename: M
authors.initials: M
authors.lastname: Fishman
authors.forename: K
authors.initials: K
authors.lastname: Masino
authors.forename: J
authors.initials: J
authors.lastname: Pi
authors.forename: J
authors.initials: J
authors.lastname: Mehta
mesh_terms: 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
chemical_list: D011994:Recombinant Proteins; C469709:rasburicase; D014527:Uric Acid; D003404:Creatinine; D014503:Urate Oxidase