Role of Hypouricemic Agents in Tumor Lysis Syndrome: A Meta-Analysis

Abstract

Objective and background: Tumor lysis syndrome (TLS) is a life-threatening emergency and demands emergency care of effective outcome with minimal or no side effects. The Hypouricemic agents, including Rasburicase, Allopurinol and Febuxostate used for the management of TLS. This study was designed to evaluate the Role of Hypouricemic agents by analyzing TLS development rate, control of uric acid, and Creatinine levels.
 Methods: An extensive electronic data search was conducted by using all leading scientific databases. Twenty-six studies were selected to conduct this study, as per the inclusion criteria.
 Results: The Odd ratio of TLS development rate was 4.06, 1.24, and 1.49 by Rusbricase, Allopurinol & Febuxostate administration respectively. 95% confidence interval was reported by selected studies against TLS development rate, Uric acid, and Creatinine levels by administrating Rusbricase, Allopurinol & Febuxostate.
 Conclusion: All Hypouricemic agents, including Rasburicase, Allopurinol and Febuxostate, are effective to manage Tumor lysis Syndrome. However, a suitable and most effective intervention dose needs to identify with better efficacy and minimal side effects both in Adults and Children.

Rasburicase in treating tumor lysis syndrome: An umbrella review

“…Significant difference in the reduction of uric acid levels between the treatment and control groups. TLS: RR (95% CI) = 0.77 (0.44–1.33) 14 Alshehri et al., 2021 39 Medline, Google Scholar, Scopus, Embase, and Cochrane from inception till April 2021 Not provided K = 20 Control trial (3) RCT (3) Cohort (3) Retrospective (11) RoB: Newcastle–Ottawa scale (NOS) Rasburicase Development of TLS (6) White blood cell count (1) Lactate dehydrogenase (2) Uric acid level (13) Creatinine (7) AKI (1) Adverse events (6) Odds ratio for the development of TLS 4.06 (3.11–5.28). A significant main effect of rasburicase for the development of TLS, uric acid level (MD = −19.96 (−22.43 to −17.49), and creatinine level ( p < 0.01) 8 AKI: Acute kidney injury; AMSTAR 2: A measurement tool to assess systematic reviews 2; CCT: Controlled clinical trail; CI: Confidence interval; CTLS: Clinical tumor lysis syndrome; EMBASE: Excerpta Medica Database; ER: Effect ratio; ICU: Intensive care unit; LTLS: Laboratory tumor lysis syndrome; MD: Mean difference; MEDLINE: Medical Literature Analysis and Retrieval System Online; NOS: Newcastle–Ottawa Scale; OR: Odds ratio; PUA: Plasma uric acid; RCT: Randomized controlled trial; RoB: Risk of bias; RR: Risk ratio; RRT: Renal replacement therapy; SDR: Single-dose rasburicase; TLS: Tumor lysis syndrome.…”

“…Three reviews discussed study heterogeneity, 31 , 33 , 38 , and the source of conflict was declared in five of the included reviews. 32 , 33 , 35 , 37 , 39 Table 2 illustrates the quality appraisal using AMSTAR 2.…”

“…Four reviews did not mention the total sample size of the included studies. 33 , 36 , 37 , 39 The sample size for one of the studies ( n = 807) by Bose et al. 36 was calculated manually from the included studies, resulting in a combined sample size of the umbrella review of 4138.…”

“… 36 was calculated manually from the included studies, resulting in a combined sample size of the umbrella review of 4138. Only two reviews mentioned the population (children or adults), 33 , 39 while another review mentioned neither population nor sample size, as no meta-analysis was conducted. 39 Three reviews included both children and adults as samples, 32 , 33 , 39 whereas the other reviews were conducted on adult patients.…”

“…Regarding the intervention, four of the nine included reviews explored the efficacy of a single dose of rasburicase for TLS outcomes, 33 , 36 , 37 , 39 while two reviews compared the efficacy of a single dose vs. a weight-based dose of rasburicase in terms of TLS outcomes. 32 , 34 The single doses of rasburicase were 1.5, 3, 4.5, 6, and 7.5 mg per day, while the weight-based doses were 0.05 and 0.15 mg/kg.…”