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Rasburicase

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Title: Rasburicase  
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Subject: Tumor lysis syndrome, Chemotherapeutic adjuvants, Acute uric acid nephropathy, Palifermin, Glucose-6-phosphate dehydrogenase deficiency
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Rasburicase

Rasburicase
Systematic (IUPAC) name
Aspergillus urate oxidase
Clinical data
AHFS/Drugs.com
Legal status
  • RX/POM
Routes of
administration
Intravenous
Pharmacokinetic data
Bioavailability N/A
Biological half-life 18 hrs
Identifiers
CAS Registry Number  Y
ATC code V03
IUPHAR/BPS
DrugBank  Y
UNII  Y
ChEMBL  N
Chemical data
Formula C1521H2381N417O461S7
Molecular mass 34109.5
 N   

Rasburicase (brand names: Elitek in the US, and Fasturtec in Europe) is a recombinant version of urate oxidase, an enzyme that metabolizes uric acid to allantoin. Urate oxidase is known to be present in many mammals but does not naturally occur in humans.[1] Rasburicase is produced by a genetically modified Saccharomyces cerevisiae strain. The cDNA coding for rasburicase was cloned from a strain of Aspergillus flavus.[1]

Rasburicase is a tetrameric protein with identical subunits. Each subunit is made up of a single 301 amino acid polypeptide chain with a molecular mass of about 34 kDa. The drug product is a sterile, white to off-white, lyophilized powder intended for intravenous administration following reconstitution with a diluent. Elitek (rasburicase) is supplied in 3 mL and 10 mL colorless, glass vials containing rasburicase at a concentration of 1.5 mg/mL after reconstitution.[2]

Contents

  • Medical uses 1
  • Side effects 2
  • Pharmacology 3
    • Mechanism of Action 3.1
    • Pharmacodynamics 3.2
    • Pharmacokinetics 3.3
  • See also 4
  • References 5
  • External links 6

Medical uses

Rasburicase is approved for use by the U.S. Food and Drug Administration (and European counterparts) for the prevention and treatment of tumor lysis syndrome (TLS)[3] in people receiving chemotherapy for hematologic cancers such as leukemias and lymphomas. It; however, is not clear if it results in important benefits such as decreased kidney problems or decreased risk of death as of 2014.[4]

It is being investigated for treating severe hyperuricemia from other sources (e.g., gout[5] and other rheumatologic conditions).

Rasburicase is much more expensive than conventional therapy.[6]

Side effects

Rasburicase administration can cause anaphylaxis (incidence unknown); methemoglobinemia may occur in susceptible individuals such as those with G6PDH deficiency due to the production of hydrogen peroxide in the urate oxidase reaction.[1] Testing patients for G6PDH deficiency prior to starting a course of rasburicase has been recommended.[1]

Pharmacology

Mechanism of Action

In humans, uric acid is the final step in the catabolic pathway of purines. Rasburicase catalyzes enzymatic oxidation of poorly soluble uric acid into an inactive and more soluble metabolite allantoin with carbon dioxide and hydrogen peroxide as byproducts in the chemical reaction.[1]

Pharmacodynamics

The measurement of plasma uric acid was used to evaluate the effectiveness of rasburicase in clinical studies. Following administration of either 0.15 or 0.20 mg/kg rasburicase daily for up to 5 days, plasma uric acid levels decreased within 4 hours and were maintained below 7.5 mg/dL in 98% of adult and 90% of pediatric patients for at least 7 days. There was no evidence of a dose response effect on uric acid control for doses between 0.15 and 0.20 mg/kg rasburicase.[2]

Pharmacokinetics

The pharmacokinetics of rasburicase were evaluated in both pediatric and adult patients with leukemia, lymphoma or other hematological malignancies. Rasburicase exposure, as measured by AUC0-24 hr and Cmax, tended to increase with a dose range from 0.15 to 0.2 mg/kg. The mean terminal half-life was similar between pediatric and adult patients and ranged from 15.7 to 22.5 hours. The mean volume of distribution of rasburicase ranged from 110 to 127 mL/kg in pediatric patients and from 75.8 to 138 mL/kg in adult patients, respectively. Minimal accumulation of rasburicase ( < 1.3 fold) was observed between days 1 and 5 of dosing. In adults, age, gender, baseline liver enzymes and creatinine clearance did not impact the pharmacokinetics of rasburicase. A cross-study comparison revealed that after administration of rasburicase at 0.15 or 0.20 mg/kg, the geometric mean values of body-weight normalized clearance were approximately 40% lower in Japanese (n=20) than that in Caucasians (n=22).[2]

See also

  • Pegloticase is a pegylated variant of the uricase enzyme which has been approved for the treatment of refractory gout.

References

  1. ^ a b c d e Wilson FP, Berns JS (October 2012). "Onco-nephrology: tumor lysis syndrome". Clin J Am Soc Nephrol 7 (10): 1730–9.  
  2. ^ a b c "Elitek (rasburicase)". Rxlist. 
  3. ^ Ho VQ, Wetzstein GA, Patterson SG, Bradbury R (April 2006). "Abbreviated rasburicase dosing for the prevention and treatment of hyperuricemia in adults at risk for tumor lysis syndrome". Supportive cancer therapy 3 (3): 178–82.  
  4. ^ Cheuk, DK; Chiang, AK; Chan, GC; Ha, SY (Aug 14, 2014). "Urate oxidase for the prevention and treatment of tumour lysis syndrome in children with cancer.". The Cochrane database of systematic reviews 8: CD006945.  
  5. ^ Cammalleri L, Malaguarnera M (2007). "Rasburicase represents a new tool for hyperuricemia in tumor lysis syndrome and in gout". International journal of medical sciences 4 (2): 83–93.  
  6. ^ Reinders MK, van Roon EN, Brouwers JR, Jansen TL (March 2005). "A costly therapeutic dilemma in tophaceous gout: is etanercept or rasburicase preferable?". Annals of the rheumatic diseases 64 (3): 516; author reply 516.  

External links

  • Elitek (Rasburicase) - Official web site of manufacturer.
  • Elitek (Rasburicase) Prescribing Information - Official Prescribing Information of manufacturer.
  • [2] - Elitek (Rasburicase)
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