Efficacy of Single Dose Rasburicase in Prophylaxis and Treatment of Tumor Lysis Syndrome: A metaanalysis

Purpose: This metaanalysis study evaluated the efficacy of single dose rasburicase (SDR) comparing with FDA approved daily dosing of rasburicase (DDR) for 5 days in adults with hyperuricemia or at high risk for TLS.

Methods: Metaanalysis of prospective and retrospective studies were retrieved from systemic search of major electronic data sources. Studies included in the metaanalysis were those with SDR for the prophylaxis of high risk TLS or treatment of hyperurecemia in adults.  The results of response rate and controlling of time dependent plasma uric acid reduction were pooled and compared with the results from patients treated with DDR for 5 days or patients treated with allopurinol.  

Results: Nine studies (Seven retrospective and two prospective) evaluated the response rate and reduction of plasma uric acid level monitored over time. The pooled total number of patients treated with SDR (from 0.15mg/kg to 0.2mg/kg) was 254. The pooled response rate of SDR was not inferior to DDR (0.2mg/kg) for 5 days (response rate: 88.24% vs. 90.18%), but much stronger than that of allopurinol (300 mg/d orally days 1 to 5) treatment group (response rate 88.24% vs. 66%). Although pooled SDR group efficiently controlled the uric acid level below 4.5 mg/dL over 12 hrs, 24hrs, 48 hrs and 72 hours, its controlling of plasma uric acid was inferior to that of DDR. Furthermore, the controlling of uric acid level for pooled higher single dose treatment (>=6mg) was stronger than that of pooled low single dose group (<6mg).

Conclusion: SDR for adults with hyperuricemia or at high risk for TLS demonstrated better response rate and stronger controlling of uric acid level compared to allopurinol. SDR response rate was not inferior to that of DDR. Additional randomized control studies are needed to confirm this metaanalysis study.