QIM20-119: The Efficacy of Cost-Effective Fixed Dose of Rasburicase Compared to Weight-Based Dose in Treatment and Prevention of Tumor Lysis Syndrome (TLS)

Introduction: Rasburicase is widely used to treat and prevent TLS in cancer patients. The Food and Drug Administration (FDA) approved dose is Intravenous 0.2 mg/kg/day for 5 days, which can cost up to 37,500$. However, many institutions adapted the use of fixed dosing for convenience and cost effectiveness. In our institution, two dosing approaches are utilized, which is mainly physician preference. In this retrospective analysis we sought to compare the efficacy between two doing approaches of the single fixed dose of Rasburicase (6 mg) compared to the weight-based dose (0.2 mg/kg/day) in decreasing the uric acid levels to <4 mg/dL by day 3. Methods: This is a single institution retrospective study enrolled all patients who were hospitalized to our institution for 111 months, between October 2008 and December 2017and received Rasburicase either 6 mg fixed dose or weight-based dose. Data was collected for age, race, gender, diagnosis, uric acid levels before and after treatment, dose of Rasburicase and number of doses received. Normality of distribution was checked with Shapiro-Wilk test and confirmed by visualizing it using histograms. Results: We enrolled 115 patients, 79 patients (69%) received fixed dose and 36 patients (31%) received weight-based dose. 83% of patients were males. Mean age was 58 ±15.5 yrs. Patients in the fixed dose group received a mean of 1.4±0.63 doses whereas patients in weight base dose group received a mean of 2.38±1.47 doses. Within weight-based dosing regimen, 19% patients had effective uric acid control and 11% had ineffective control. In the fixed dosing group 33% patients had effective uric acid control and 37% patients had ineffective control. There was no difference between fixed vs weight-based dosing regimen in bringing the uric acid level <4mg/dL (chi-square=1.67, p-value=0.19). Although there was a significant difference in before and after uric acid levels with the use of Rasburicase(p<0.001). Conclusion: In this single center retrospective study, there was no statistical difference in the efficacy between the fixed dose compared to weight-based dosing regimen. Given the lower costs associated with fixed dosing, and the availability of similar evidence that has been recently emerging, this can be a potentially cost saving intervention without compromising clinical efficacy and patient outcomes.

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Corresponding Author: Ahmad M. Abu-Hashyeh, MBBS
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