Evaluation of rasburicase use in the fraser health authority: A retrospective review

Abstract

Background: Rasburicase, a recombinant urate oxidase, is restricted in die Fraser Health Authority (FHA) to the "treatment of acute or at high risk of tumour lysis syndrome [TLS], when other therapeutic options are not suitable". The manufacturers recommended dosage is 0.2 mg/kg daily for up to 7 days. Given the high cost of this drug, several studies have investigated other strategies and found that a single dose, repeated as needed, is effective in reducing serum uric acid. However, there are currendy no guidelines in FHA for the use of rasburicase, which may result in different prescribing practices within the health authority. Objectives: To describe the prescribing of rasburicase in FHA, including indications and doses, and to report the uric acid-lowering effects of rasburicase and any clinical outcomes, such as dialysis or death. Methods: This retrospective descriptive chart review included adult patients receiving care in FHA for whom rasburicase was prescribed between June 1, 2010, and November 30, 2016. Descriptive statistics were used to summarize patient characteristics and results. Results: The prescribing practices for rasburicase in this health authority were largely inconsistent, but the most common dose administered was 3 mg (8/12 [67%] among those receiving rasburicase for prophylaxis and 9/32 [28%] among those receiving rasburicase for treatment; combined total 17/44 or 39%). Regardless of dose, rasburicase reduced serum uric acid levels to less than 476 umol/L and decreased the risk of TLS. Conclusions: Having a uniform approach-involving a single dose that can be repeated as needed-for prevention and treatment of elevated serum uric acid levels could result in sufficient reduction of uric acid levels with fewer doses and lower cost. The results of this study support the need for a resource in FHA to guide and standardize the use of rasburicase.