Gerstein, Rachael, PharmD

Held Wheatley, Kristin M, PharmD, BCOP

Kincaid, Hope, MPH, CPH

Mancheril, Arun, PharmD, BCPS

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works Department of Pharmacy Evaluation of Rasburicase Utilization for Hyperuricemia Rachael Gerstein PharmD Arun Mancheril PharmD, BCPS Hope Kincaid MPH, CPH Kristin M. Held Wheatley PharmD, BCOP Follow this and additional works at: https://scholarlyworks.lvhn.org/pharmacy  Part of the Pharmacy and Pharmaceutical Sciences Commons This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. © 2019 Lehigh Valley Health NetworkLVHN.orgEvaluation of Rasburicase Utilization for HyperuricemiaRachael L. Gerstein, PharmD; Arun Mancheril, PharmD, BCPS; Hope Kincaid, MPH, CPH; Kristin Held Wheatley, PharmD, BCOPLehigh Valley Health Network, Allentown, PABackground•  Tumor lysis syndrome (TLS) is an oncologic emergency that occurs due to a rapid lysis of malignant cells that overwhelms the normal homeostatic mechanisms leading to hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and uremia•  Treatment of TLS involves hydration, correction of electrolyte abnormalities, administration of a xanthine oxidase inhibitor, administration of rasburicase, and possibly dialysis•  Rasburicase (Elitek®) is an Aspergillus-derived recombinant urate oxidase approved for treatment of hyperuricemia associated with malignancy•  Due to its significant cost, rasburicase should be reserved for patients who are at high risk for TLS, including high tumor burden, treatment with highly active cell-cycle specific chemotherapy agents, pre-existing renal dysfunction, or uric acid ≥ 8 mg/dL•  As a cost savings initiative, numerous studies have shown successful reduction of uric acid with single-dose rasburicase leading to dosing recommendations being expanded to include single-dose rasburicase of 3mg or 6mgObjectivesPrimary Objective •  Calculate percentage of patients who received rasburicase that met high-risk criteria for TLSSecondary Objectives•  Calculate percentage of patients who received allopurinol prior to rasburicase•  Calculate percentage of patients who achieved uric acid ≤ 8 mg/dL 24 hours after a single dose of rasburicase stratified by rasburicase dose (3mg or 6mg)•  Evaluate cost savings of utilizing single-dose of rasburicase 3mg for patients that qualified for this doseMethods •  A retrospective chart review was conducted for inpatients 18 years and older that received rasburicase at Lehigh Valley Hospital-Cedar Crest and Muhlenberg campuses from January 1, 2017 to August 19, 2019•  High-risk criteria for TLS was defined as patients with an oncology diagnosis and EITHER a lactate dehydrogenase (LD) > 2 times the upper limit of normal OR WBC  > 25 K/uL, AND uric acid ≥ 8 mg/dL or 25% increase from baseline•  Statistical analysis included descriptive statistics for demographics and baseline characteristics, calculated frequencies and percentages for categorical variables, and calculated average with standard deviation for normally distributed continuous variablesResults Patient Characteristics (N=121) N(%)Male 79 (65.3)Oncology Diagnosis 115 (95.0)Hematologic 87 (75.7)Solid 16 (13.9)Other 12 (10.4)G6PD deficiency statusNegative 8 (6.6)Unknown 113 (93.4) Hemodialysis Required 20 (16.5)Rasburicase Dose (N=155)3mg Dose 53 (34.2)6mg Dose 99 (63.9)Other Dose* 3 (1.9)Average ±  Standard DeviationAge (years) 66.0 ± 12.1Weight (kg) 90.5 ± 22.8Laboratory Concentrations prior to RasburicaseWBC (K/uL) 41.2 ± 67.4  LD (unit/L) 1253.5 ± 1590.8Potassium (mmol/L) 4.4 ± 0.8Phosphorus (mg/dL) 4.6 ± 1.6Calcium (mg/dL) 8.4 ± 1.1Uric acid (mg/dL) 11.3 ± 4.2Serum creatinine (mg/dL) 2.4 ± 1.8* Other Doses: 1.5mg, 9mg, 12mgConclusion•  Out of all patients that received rasburicase,  64 patients met high-risk criteria for TLS with 35.9% meeting WBC criteria and 84.4% meeting LD criteria•  Total of 75.2% of patients achieved uric acid  ≤ 8 mg/dL 24 hours after a single dose of rasburicase•  There were 50 patients that received 6mg of rasburicase that qualified for a lower dose of 3mg due to a uric acid ≤ 12 mg/dL at time of confirmed TLS associated with a potential cost savings of $104,055•  Further discussion is warranted into implementing ordering criteria for rasburicase due to the potential cost savings of $207,069.45 for patients that did not meet the specified criteriaReferences1.  Coiffier B, Altman A, Pui C, et al. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol. 2008;26(16):2767-2778.2.  Kraus SK, Burdalski CE, Timlin C, et al. A comparison of single dose rasburicase 3 mg versus 6 mg for the management of tumor lysis syndrome. Blood. 2015;126(23):4511.3.  Patel K, Brown T, Gupta A, et al. Decreasing inappropriate use of rasburicase to promote cost-effective care. J Oncol Pract. 2019;15(2):e178-e186. Authors of this presentation have nothing to disclose related to the subject of this poster.Patients Who Met High-Risk Criteria and  Patients Who Received Allopurinol0102030405060708090Met high-risk TLS criteriaAllopurinol use prior to RasburicasePercentage of Patients52.9%42.1%Achievement of Uric Acid ≤ 8 mg/dL 24 Hours  After a Single Dose of Rasburicase0102030405060708090Received 3mg dose Received 6mg dosePercentage of Patients62.9%81.2%Potential Cost Savings of Implementing Rasburicase 3mg Single Dose When Uric Acid ≤ 12 mg/dL050,000100,000150,000200,000250,000300,000350,000400,000450,000Cost of 3mg and 6mg dosesLower 3mg dose implementedCost ($)$427,666.05$323,611.05

Evaluation of Rasburicase Utilization for Hyperuricemia

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Evaluation of Rasburicase Utilization for Hyperuricemia

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