<p>Length of stay, mortality, and readmissions among Medicare cancer patients treated with glucarpidase and conventional care: a retrospective study</p>

Abstract

PurposeGlucarpidase (Voraxaze) is used to treat methotrexate (Mtx) toxicity in patients with delayed Mtx clearance due to impaired renal function. We examine hospital length of stay (LOS), mortality, and readmission rates for Medicare cancer patients with delayed clearance of Mtx treated with glucarpidase.MethodsUsing 2010–2017 Medicare claims data, we identified glucarpidase patients as those hospitalized with indications of select lymphomas or leukemia, inpatient chemotherapy, and glucarpidase treatment. We assessed outcomes of glucarpidase patients relative to those experienced by patients treated for presumed Mtx toxicity using other therapies. These nonglucarpidase patients were identified with a diagnosis of primary central nervous system lymphoma, indications of cancer-chemotherapy toxicity, and acute kidney injury during hospitalization (not present on admission), and were divided into two groups: treated with dialysis (dialysis+) and treated with or without dialysis (dialysis+/−). Inverse-probability treatment weighting using propensity scores was used to adjust for differences between groups.ResultsPatients treated with glucarpidase (n=30) had an average LOS of 14.7 days. They had inpatient, 30-day, and 90-day mortality rates of 3.3%, 13.3%, and 16.7%, respectively, and a 90-day all-cause unplanned readmission rate of 24.1%. The dialysis+ and dialysis+/− groups, respectively, had higher average LOS (40.2, 21.9), higher inpatient mortality (50.6%, 20.8%), and higher 90-day mortality (58.6%, 37.6%). No statistically significant differences in 30-day mortality or 90-day readmission rates were detected between the glucarpidase group and either of the nonglucarpidase groups. Unobservable differences in patient severity may impact the interpretation of our findings.ConclusionMedicare cancer patients with presumed Mtx toxicity receiving conventional treatment experience long hospitalizations, high intensive-care unit use and high mortality. Glucarpidase patients had lower LOS, inpatient mortality, and 90-day mortality than the non-glucarpidase patients.

Prevalence of physical and mental health conditions in Medicare-enrolled, autistic older adults

“…Consistent with practices in existing literature (e.g. Demiralp et al, 2019; Lankiewicz et al, 2018; Mahr et al, 2018), we excluded beneficiaries enrolled in Medicare Advantage Plans due to concerns regarding the availability of accurate, complete data in these managed care programs. A PC group of beneficiaries without autism diagnoses was selected at a 10:1 ratio to autistic beneficiaries using group frequency matching for 5-year age category and sex.…”

Health status of Medicare-enrolled autistic older adults with and without co-occurring intellectual disability: An analysis of inpatient and institutional outpatient medical claims

“…We excluded beneficiaries enrolled in Medicare Advantage Plans due to concerns regarding the availability of accurate, complete data (Demiralp et al, 2019; Lankiewicz et al, 2018; Mahr et al, 2018). We also excluded Medicare-enrolled autistic adults under the age of 65 years.…”

Half-dose glucarpidase as efficient rescue for toxic methotrexate levels in patients with acute kidney injury

“…Recently, an epidemiological study suggested that administration of glucarpidase may reduce mortality rates [ 21 ]. However, no randomized controlled study has formally proven that MTX level reduction by glucarpidase is associated with a favorable clinical outcome like decrease in MTX-induced toxicities, recovery of renal function or survival.…”

“…Levels obtained after glucarpidase administration were consistently < 10 µmol/L; therefore, manageable with continued intensified FA rescue. As randomized placebo controlled clinical studies to define the clinical effectiveness of glucarpidase are unlikely to be performed, at least dose finding studies including pharmacokinetic analysis and assessment of clinical outcome measures are urgently needed [ 21 , 28 ]. Our study supports the use of glucarpidase below the recommended dose of the prescribing information which also translates into a significant economic benefit.…”