학술논문
Clinical Experience of the Efficacy and Safety of Low-dose ToIvaptan Therapy in a UK Tertiary Oncology Setting
Clinical Research Article
Clinical Research Article
Document Type
Academic Journal
Author
Source
Journal of Clinical Endocrinology & Metabolism. November 2021, Vol. 106 Issue 11, pe4766, 10 p.
Subject
Language
English
ISSN
0021-972X
Abstract
Hyponatremia secondary to the syndrome of inappropriate antidiuresis (SIAD) is common in patients with cancer, with up to 15% of patients with small cell lung cancer (SCLC) being affected (1). [...]
Context: In patients with cancer, hyponatremia is associated with increased morbidity and mortality and can delay systemic therapy. Objective: To assess the safety and efficacy of low-dose tolvaptan (7.5 mg) for hospitalized, adult patients with hyponatremia due to syndrome of inappropriate antidiuresis (SIAD), and coexisting malignancy. Methods: Retrospective evaluation in a tertiary cancer center. Results: Fifty-five patients with mean baseline serum sodium (sNa) 117.9 [+ or -]4.6 mmol/L were included. In total, 90.9% had severe hyponatremia (sNa130 mmol/L and 48 (87.3%) had sNa rise of >5 mmol/L within 48 hours. No severe adverse events were reported. Thirty-three (60%) and 17 (30.9%) patients experienced sNa rise of >8and >12 mmol/L/24 hours, respectively.The rate of sNa correction in the first 24 hours was significantly higher among participants that continued fluid restriction after tolvaptan administration (median [quantiles]: 14 [9-16] versus 8 [5-11] mmol/L, P=.036). Moreover, in the over-rapid correction cohort (>12 mmol/L/24 hours) demeclocycline was appropriately discontinued only in 60% compared with 91.7% of the remaining participants (P-.047). Lower creatinine was predictive of higher sNa correction rate within 24 hours (P-.01). Conclusion: In the largest series to date, although low-dose tolvaptan was demonstrated to be effective in correcting hyponatremia due to SIAD in cancer patients, a significant proportion experienced over-rapid correction. Concurrent administration of demeclocycline and/or fluid restriction must be avoided due to the increased risk of overrapid correction. Key Words: Hyponatremia, SIAD, cancer, tolvaptan, safety
Context: In patients with cancer, hyponatremia is associated with increased morbidity and mortality and can delay systemic therapy. Objective: To assess the safety and efficacy of low-dose tolvaptan (7.5 mg) for hospitalized, adult patients with hyponatremia due to syndrome of inappropriate antidiuresis (SIAD), and coexisting malignancy. Methods: Retrospective evaluation in a tertiary cancer center. Results: Fifty-five patients with mean baseline serum sodium (sNa) 117.9 [+ or -]4.6 mmol/L were included. In total, 90.9% had severe hyponatremia (sNa130 mmol/L and 48 (87.3%) had sNa rise of >5 mmol/L within 48 hours. No severe adverse events were reported. Thirty-three (60%) and 17 (30.9%) patients experienced sNa rise of >8and >12 mmol/L/24 hours, respectively.The rate of sNa correction in the first 24 hours was significantly higher among participants that continued fluid restriction after tolvaptan administration (median [quantiles]: 14 [9-16] versus 8 [5-11] mmol/L, P=.036). Moreover, in the over-rapid correction cohort (>12 mmol/L/24 hours) demeclocycline was appropriately discontinued only in 60% compared with 91.7% of the remaining participants (P-.047). Lower creatinine was predictive of higher sNa correction rate within 24 hours (P-.01). Conclusion: In the largest series to date, although low-dose tolvaptan was demonstrated to be effective in correcting hyponatremia due to SIAD in cancer patients, a significant proportion experienced over-rapid correction. Concurrent administration of demeclocycline and/or fluid restriction must be avoided due to the increased risk of overrapid correction. Key Words: Hyponatremia, SIAD, cancer, tolvaptan, safety