Hospital Outcomes

Use of Voraxaze® Leads to Reduced Length of Stay and Reduced Mortality Rates1

In a retrospective study of Medicare patients with cancer, patients treated with Voraxaze® had all of the following benefits compared to nonglucarpidase patients treated with dialysis (dialysis+) and nonglucarpidase patients with or without dialysis treatment (dialysis+/-), respectively1*:
  • Shorter mean hospital length of stay (14.7 days vs 40.2 days and 21.9 days)
  • Shorter mean ICU length of stay (4.0 days vs 18.2 days in the dialysis+ group)
  • Lower inpatient mortality rates (3.3% vs 50.6% and 20.8%)
  • Lower 90-day mortality rates (16.7% vs 58.6% and 37.6%)
*Utilizing Medicare inpatient claims data between 2010 and 2017, investigators compared outcomes and healthcare resource utilization between patients treated with Voraxaze® (n=30) and patients not treated with Voraxaze® (n=701), all of whom had experienced AKI secondary to inpatient chemotherapy.
Mean length of stay (LOS) among patients treated with Voraxaze® and the non-Voraxaze® groups1
Chart demonstrating reduced LOS for Voraxaze® patients
Rates of mortality among patients treated with Voraxaze® and the non-Voraxaze® groups1
Chart demonstrating reduced mortality rates for Voraxaze® patients

Early vs Late Treatment With Voraxaze®1

Voraxaze® patients treated within 3 days of admission (n=18) had shorter ICU and hospital LOS compared to Voraxaze® patients treated after 3 days (n=12).
Early cohort Late cohort
Overall length of stay 10.0 days 21.7 days (P=0.002)
Length of hospital stay after Voraxaze® 8.5 days 14.6 days (P=0.057)
Length of ICU stay 0.8 days 8.9 days (P=0.020)

Trust Voraxaze® for Rapid and Sustained Reductions in MTX

Not every patient requires Voraxaze®, but experts have assembled recommendations to help guide treatment.

Explore the guidelines for the use and stocking of Voraxaze® so that you’re prepared in an emergency.

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References

  1. Voraxaze® [prescribing information]. BTG International Inc; 2013.
  2. Howard SC, et al. Preventing and managing toxicities of high-dose methotrexate. The Oncologist 2016; 21:1-12.
  3. Widemann BC, Balis FM, Kim A, et al. Glucarpidase, leucovorin, and thymidine for high-dose methotrexate-induced renal dysfunction: clinical and pharmacologic factors affecting outcome. J Clin Oncol. 2010; 28:3979-3986.
  4. 2013 Annual Meeting of the North American Congress of Clinical Toxicology (NACCT), Clinical Toxicology 2013; 51(7):575-724. doi:10.3109/15563650.2013.817658.
  5. Ramsey L, Balis FM, O’Brien MM, et al. Consensus guidelines for use of glucarpidase in patients with high-dose methotrexate induced acute kidney injury and delayed methotrexate clearance. Durham, NC. The Oncologist. 2017 Oct 27. doi: 10.1634/theoncologist.2017-0243
  6. Widemann BC, Adamson PC. Understanding and managing methotrexate nephrotoxicity. Oncologist. 2006;11:694-703
  7. Schwartz S, Borner K,Müller K, et al. Glucarpidase (carboxypeptidase G2) intervention in adult and elderly cancer patients with renal dysfunction and delayed methotrexate elimination after high-dose methotrexate therapy. Oncologist. 2007;12:1299-1308.
  8. Widemann BC, Balis FM, Kempf-Bielack B, et al. High-dose methotrexate-induced nephrotoxicity in patients with osteosarcoma. Cancer. 2004;100:2222-2232
  9. Data on file. BTG International Inc. 2012.
  10. de Miguel D, García-Suárez J Martín Y, Gil-Fernández JJ, Burgaleta C. Severe acute renal failure following high-dose methotrexate therapy in adults with haematological malignancies: a significant number result from unrecognized co-administration of several drugs. Nephrol Dial Transplant. 2008;23:3762-3766.
  11. Jahnke K, Korfel A, Martus P, et al; on behalf of the German Primary Central Nervous System Lymphoma Study Group (G-PCNSL-SG). High-dose methotrexate toxicity in elderly patients with primary central nervous system lymphoma. Ann Oncol. 2005;16:445-449
  12. Flombaum C, Meyers P. High-dose leucovorin as sole therapy for methotrexate toxicity. Journal of Clinical Oncology 1999; 17(5): 1589-1594.
  13. Murashima M, et al. Methotrexate clearance by high-flux hemodialysis and peritoneal dialysis: a case report. Am J Kidney Dis 2009; 53:781-874.
  14. Wall S, Johansen M, et al. Effective clearance of methotrexate using high-flux hemodialysis membranes. Am J Kidney Dis 1996; 28(6):846-854.
  15. Dart RC, Goldfrank LR, Erstad BL, et al. Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care. Ann Emerg Med. 2018;71(3):314-325.
  16. Green JM. Glucarpidase to combat toxic levels of methotrexate in patients. Ther Clin Risk Manag. 2012;8:403-4
  17. Glucarpidase (Voraxaze®) National Drug Monograph and Considerations for Use. U.S. Department of Veterans Affairs website. 2014. http://www.pbm.va.gov/clinicalguidance/drugmonographs/Glucarpidase_ Drug_Monograph_and_Considerations_for_Use.doc. Published June 2014. Accessed November 04, 2016.
  18. Leucovorin [prescribing information]. Bedford Laboratories; 2011.