Early treatment with rasburicase and risk of kidney replacement therapy and death in adults with tumour lysis syndrome: emulated target trial.
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Shenoy Tushar, Sanchez-Almanzar Daniel, Dias Julie-Alexia, Hayden Robert, Shashaty Michael Gs, Aklilu Abinet M, Patell Rushad, Anand Shuchi, Renaghan Amanda, Bassil Claude, Neyra Javier A, Bansal Anip, Shah Chintan V, Gupta Shruti, Sise Meghan E, Seethapathy Rituvanthikaa, Chase Sydney, Thompson Cyrilee, Radhakrishnan Raghu, Verma Eesha, Ni Jian, Hoge Steven T, Lypka Victoria, Ali Rafia, Monson Audrey E, Kaunfer Sarah, Angus Elizabeth, Griffiths Stephen, Walling Clara, Al Haddad Nadia, Brotman Christina Hw, Miano Todd, Shirali Anushree C, Turco David J, Alleyne Saieda A, Shelton Kyra, Shaefi Shahzad, Garcia Daniela, Nasim Atif, Jan Naveed, Nguyen Phuong H, Ziolkowski Susan, Subramanian Nivetha, Subramanian Vigneshwar, Debnath Neha, Faldu Czarina T, Wickramasinghe Kavindya, Donahue Brian P, Shah Anish, Shostak Jessica, Jayakumar Vaishnavi, Nadayil Jasmine, Baz Rachid, Takeuchi Tomonori, Renzi Stefania, Rehman Aqeeb Ur, Nombera-Aznaran Natalia, Charkviani Mariam, Kotzin Megan, Kaiser Jeff, Edwards Madison, Mathavan Akash, Mathavan Akshay, Obimdike Faith, Shah Nikita, LaCasce Ann S, Armand Philippe, Leaf David E
Аннотация
DESIGN: Emulated target trial.
SETTING: 36 US hospitals.
PARTICIPANTS: 1276 adults (≥18 years) admitted to hospital between 2014 and 2023 with active haematological malignancy or solid tumour with metastases, high tumour burden, or laboratory findings and clinical features consistent with TLS.
MAIN OUTCOME MEASURES: The primary outcome was a composite of acute kidney injury requiring kidney replacement therapy or death during the index hospital admission. A key secondary outcome was 90 day mortality. Outcomes were compared between patients who received rasburicase within 12 hours after TLS onset and those who did not, using logistic regression with inverse probability of treatment weighting to adjust for confounding.
RESULTS: Among 1276 patients included in the analysis, 705 (55.3%) received rasburicase within 12 hours after TLS onset. Among patients treated within 12 hours of TLS onset, rasburicase was administered at a median of 5.0 hours (interquartile range 3.1-7.5 hours). Patients who received rasburicase had higher uric acid concentrations than those who did not (median 0.71 v 0.59 mmol/L (11.9 v 9.9 mg/dL)); however, severity of illness was well balanced after applying inverse probability of treatment weighting. Early rasburicase treatment was associated with a lower risk of acute kidney injury requiring kidney replacement therapy or death (32.7% v 42.0%; adjusted odds ratio 0.67, 95% confidence interval 0.52 to 0.88; P<0.001). Results were consistent across multiple sensitivity analyses and for 90 day mortality (adjusted odds ratio 0.71, 0.54 to 0.94).
CONCLUSIONS: Among adults with TLS, early rasburicase treatment for TLS was associated with about one third lower risk of acute kidney injury requiring kidney replacement therapy or death compared with delayed or no rasburicase treatment.