Clinical Experience of the Efficacy and Safety of Low-dose Tolvaptan Therapy in a UK Tertiary Oncology Setting.
J Clin Endocrinol Metab
; 106(11): e4766-e4775, 2021 10 21.
Article
em En
| MEDLINE
| ID: mdl-33693944
ABSTRACT
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) 117.9â ±â 4.6 mmol/L were included. In total, 90.9% had severe hyponatremia (sNaâ <â 125 mmol/L). Mean age was 65.1â ±â 9.3 years. Following an initial dose of tolvaptan 7.5 mg, median (range) increase in sNa observed at 24 hours was 9 (1-19) mmol/L. Within 1 week, 39 patients (70.9%) reached sNaâ ≥â 130 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 ≥8 and ≥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, Pâ =â .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 (Pâ =â .047). Lower creatinine was predictive of higher sNa correction rate within 24 hours (Pâ =â .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 over-rapid correction.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Antagonistas dos Receptores de Hormônios Antidiuréticos
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Tolvaptan
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Hiponatremia
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Neoplasias
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article