Раннее применение расбуриказы снижает риск почечной недостаточности и смертности у взрослых с синдромом лизиса опухоли

In adults experiencing tumor lysis syndrome (TLS), early rasburicase treatment may reduce the risk for acute kidney injury (AKI) requiring kidney replacement therapy or contributing to death, a recent BMJ study finds. Investigators conducted an emulated target trial called the Study of the Treatment and Outcomes in Patients with Tumour Lysis Syndrome (STOP-TLS). It involved 1276 adult patients admitted to a hospital with tumor lysis syndrome at 36 sites within 10 medical centers across 9 US states between 2014 and 2023. Patients had known or suspected active hematological malignancy or metastatic solid tumors. The study’s primary outcome was a composite of AKI requiring kidney replacement therapy or death during the index admission. Rasburicase was appropriately administered within 12 hours of tumor lysis syndrome onset in 55.3% of patients, with the median time 5.0 hours (interquartile range, 3.1-7.5 hours). The remaining 44.7% of patients did not receive timely rasburicase, of whom 33.8% received rasburicase more than 12 hours after onset and 66.2% never received the uric acid-lowering drug. Early rasburicase recipients had higher baseline levels of uric acid compared with the rest (median 11.9 vs 9.9 mg/dL). After inverse probability of treatment weighting (IPTW), the risk for AKI requiring kidney replacement therapy or death was lower for patients who received early rasburicase treatment: 32.7% vs 42.0%. The early rasburicase group had an absolute 9.3% decreased risk of severe AKI (adjusted odds ratio [aOR], 0.67; 95% CI, 0.52-0.88; absolute risk difference, -9.3%; 95% CI, -15.4% to -3.0%; P <.001). The number needed to treat was 11 patients. The likelihood of death within 90 days was lower for patients receiving vs not receiving early rasburicase (aOR, 0.71; 95% CI, 0.54-0.94). The team suggested that future studies investigate optimal rasburicase timing, dosing, and patient selection and potential barriers to early use. Disclosures: Some authors have declared affiliations with or received grant support from the pharmaceutical industry. Please refer to the original study for a full list of disclosures. References: Shenoy T, Sanchez-Almanzar D, Dias J-A, et al. Early treatment with rasburicase and risk of kidney replacement therapy and death in adults with tumour lysis syndrome: emulated target trial. BMJ. 394:e100040. doi:10.1136/bmj-2026-100040