title: Rasburicase in tumor lysis syndrome of the adult: a systematic review and meta-analysis.
abstract: BACKGROUND
  The use of rasburicase has been evaluated extensively in children, but not in adults. We review the current literature to evaluate its effect on adults.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Adults receiving rasburicase for tumor lysis syndrome (TLS).
  
  
  METHODS
  Electronic 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.
  
  
  METHODS
  Rasburicase for TLS.
  
  
  RESULTS
  The 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.
  
  
  RESULTS
  21 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.
  
  
  CONCLUSIONS
  Controlled trials differed in outcomes reported; meta-analysis was not performed.
  
  
  CONCLUSIONS
  Rasburicase 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.
authors.affiliation: Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. amlopezo@mdanderson.org
authors.forename: Maria A
authors.initials: MA
authors.lastname: Lopez-Olivo
authors.forename: Gregory
authors.initials: G
authors.lastname: Pratt
authors.forename: Shana L
authors.initials: SL
authors.lastname: Palla
authors.forename: Abdulla
authors.initials: A
authors.lastname: Salahudeen
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects; D002986:Clinical Trials as Topic / Q000379:methods; D006801:Humans; D011994:Recombinant Proteins / Q000627:therapeutic use*; D016896:Treatment Outcome; D015275:Tumor Lysis Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D014503:Urate Oxidase / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D011994:Recombinant Proteins; C469709:rasburicase; D014503:Urate Oxidase
keywords: Recombinant urate oxidase; acute kidney injury; allopurinol; cost; hyperuricemia; leukemia; lymphoma; nonrecombinant urate oxidase; outcomes; rasburicase; tumor lysis syndrome (TLS)