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Article: Urate oxidase for the prevention and treatment of tumor lysis syndrome in children with cancer.

TitleUrate oxidase for the prevention and treatment of tumor lysis syndrome in children with cancer.
Authors
Issue Date2010
PublisherJohn Wiley & Sons Ltd. The Journal's web site is located at http://www.mrw.interscience.wiley.com/cochrane/cochrane_clsysrev_articles_fs.html
Citation
Cochrane Database Of Systematic Reviews (Online), 2010, v. 6, p. CD006945 How to Cite?
AbstractBACKGROUND: Tumor lysis syndrome (TLS) is a serious complication of malignancies and can result in renal failure or death. Preliminary reports suggest that urate oxidase is highly effective in reducing serum uric acid. It is uncertain whether high quality evidence exists to support its routine use in children with malignancies. OBJECTIVES: We aimed to determine the effectiveness and safety of urate oxidase in the prevention and treatment of TLS in children with malignancies. SEARCH STRATEGY: We performed a comprehensive search of the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library issue 2, 2009), MEDLINE (1966 to 2009), EMBASE (1980 to 2009) and CINAHL (1982 to 2009). SELECTION CRITERIA: Randomized controlled trials (RCT) and controlled clinical trials (CCT) evaluating urate oxidase for the prevention or treatment of TLS in children under 18 years with any malignancy. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted trial data and assessed individual trial quality. We used relative risk (RR) for binary data and mean difference (MD) for continuous data. MAIN RESULTS: We included five trials, involved 336 patients in the treatment groups and 458 patients in the control groups. One RCT and three CCTs compared urate oxidase and allopurinol. Two trials tested Uricozyme and two tested rasburicase for the prevention of TLS. The RCT showed no significant difference in mortality or renal failure between the treatment and the control groups. The frequency of normalization of uric acid (RR 19.09, 95% CI 1.28 to 285.41) and area under curve of uric acid (MD -201, 95% CI to -258.05 to -143.95) were significantly better in the treatment group. One patient developed hemolysis. One CCT reported significantly lower mortality due to TLS (RR 0.05, 95% CI 0.00 to 0.89) and lower incidence of renal failure (RR 0.13, 95% CI 0.05 to 0.35) in the treatment group. Another CCT found significantly lower uric acid in the treatment group at 72 hours (MD -98.33, 95% CI -170.66 to -26) and 168 hours (MD -103.67, 95% CI -179.00 to -28.34). All included trials are highly susceptible to biases.Another included RCT with 30 patients compared different doses of rasburicase (0.2 mg/kg versus 0.15 mg/kg), which demonstrated similar efficacy in the reduction of uric acid. Adverse events occurred in 20% of patients, including hemolysis, hypersensitivity and anemia. AUTHORS' CONCLUSIONS: Although urate oxidase might be effective in reducing serum uric acid, it is still unclear whether this translates into a reduction in mortality or renal failure. Clinicians should weigh the potential benefits of reducing uric acid and uncertain benefits of preventing renal failure or mortality from TLS against the potential risk of adverse effects.
Persistent Identifierhttp://hdl.handle.net/10722/125249
ISSN
2014 Impact Factor: 6.035
2015 SCImago Journal Rankings: 2.366
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorCheuk, DKen_HK
dc.contributor.authorChiang, AKen_HK
dc.contributor.authorChan, GCen_HK
dc.contributor.authorHa, SYen_HK
dc.date.accessioned2010-10-31T11:19:55Z-
dc.date.available2010-10-31T11:19:55Z-
dc.date.issued2010en_HK
dc.identifier.citationCochrane Database Of Systematic Reviews (Online), 2010, v. 6, p. CD006945en_HK
dc.identifier.issn1469-493Xen_HK
dc.identifier.urihttp://hdl.handle.net/10722/125249-
dc.description.abstractBACKGROUND: Tumor lysis syndrome (TLS) is a serious complication of malignancies and can result in renal failure or death. Preliminary reports suggest that urate oxidase is highly effective in reducing serum uric acid. It is uncertain whether high quality evidence exists to support its routine use in children with malignancies. OBJECTIVES: We aimed to determine the effectiveness and safety of urate oxidase in the prevention and treatment of TLS in children with malignancies. SEARCH STRATEGY: We performed a comprehensive search of the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library issue 2, 2009), MEDLINE (1966 to 2009), EMBASE (1980 to 2009) and CINAHL (1982 to 2009). SELECTION CRITERIA: Randomized controlled trials (RCT) and controlled clinical trials (CCT) evaluating urate oxidase for the prevention or treatment of TLS in children under 18 years with any malignancy. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted trial data and assessed individual trial quality. We used relative risk (RR) for binary data and mean difference (MD) for continuous data. MAIN RESULTS: We included five trials, involved 336 patients in the treatment groups and 458 patients in the control groups. One RCT and three CCTs compared urate oxidase and allopurinol. Two trials tested Uricozyme and two tested rasburicase for the prevention of TLS. The RCT showed no significant difference in mortality or renal failure between the treatment and the control groups. The frequency of normalization of uric acid (RR 19.09, 95% CI 1.28 to 285.41) and area under curve of uric acid (MD -201, 95% CI to -258.05 to -143.95) were significantly better in the treatment group. One patient developed hemolysis. One CCT reported significantly lower mortality due to TLS (RR 0.05, 95% CI 0.00 to 0.89) and lower incidence of renal failure (RR 0.13, 95% CI 0.05 to 0.35) in the treatment group. Another CCT found significantly lower uric acid in the treatment group at 72 hours (MD -98.33, 95% CI -170.66 to -26) and 168 hours (MD -103.67, 95% CI -179.00 to -28.34). All included trials are highly susceptible to biases.Another included RCT with 30 patients compared different doses of rasburicase (0.2 mg/kg versus 0.15 mg/kg), which demonstrated similar efficacy in the reduction of uric acid. Adverse events occurred in 20% of patients, including hemolysis, hypersensitivity and anemia. AUTHORS' CONCLUSIONS: Although urate oxidase might be effective in reducing serum uric acid, it is still unclear whether this translates into a reduction in mortality or renal failure. Clinicians should weigh the potential benefits of reducing uric acid and uncertain benefits of preventing renal failure or mortality from TLS against the potential risk of adverse effects.en_HK
dc.languageengen_HK
dc.publisherJohn Wiley & Sons Ltd. The Journal's web site is located at http://www.mrw.interscience.wiley.com/cochrane/cochrane_clsysrev_articles_fs.htmlen_HK
dc.relation.ispartofCochrane database of systematic reviews (Online)en_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.rightsCochrane Database of Systematic Reviews. Copyright © John Wiley & Sons Ltd.-
dc.rightsThis review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2010, Issue 6. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.-
dc.subject.meshAllopurinol - therapeutic use-
dc.subject.meshAntimetabolites - therapeutic use-
dc.subject.meshControlled Clinical Trials as Topic-
dc.subject.meshTumor Lysis Syndrome - mortality - prevention and control-
dc.subject.meshUrate Oxidase - adverse effects - therapeutic use-
dc.titleUrate oxidase for the prevention and treatment of tumor lysis syndrome in children with cancer.en_HK
dc.typeArticleen_HK
dc.identifier.emailChiang, AK:chiangak@hkucc.hku.hken_HK
dc.identifier.emailChan, GC:gcfchan@hkucc.hku.hken_HK
dc.identifier.authorityChiang, AK=rp00403en_HK
dc.identifier.authorityChan, GC=rp00431en_HK
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1002/14651858.CD006945.pub2-
dc.identifier.pmid20556770-
dc.identifier.scopuseid_2-s2.0-77954969591en_HK
dc.identifier.hkuros179093en_HK
dc.identifier.volume6en_HK
dc.identifier.spageCD006945en_HK
dc.identifier.epageCD006945en_HK
dc.identifier.isiWOS:000278858300016-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridCheuk, DK=8705936100en_HK
dc.identifier.scopusauthoridChiang, AK=7101623534en_HK
dc.identifier.scopusauthoridChan, GC=16160154400en_HK
dc.identifier.scopusauthoridHa, SY=7202501115en_HK

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