Drug updated on 9/4/2024
| Dosage Form | Injection (intravenous; 1,000 units/vial) |
| Drug Class | Carboxypeptidases |
| Ongoing and Completed Studies | ClinicalTrials.gov |
Indication
- Indicated for the treatment of toxic plasma methotrexate concentrations (>1 micromole per liter) in patients with delayed methotrexate clearance due to impaired renal function.
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Summary
- Voraxaze (glucarpidase) is indicated for the treatment of toxic plasma methotrexate concentrations (>1 micromole per liter) in patients with delayed methotrexate clearance due to impaired renal function.
- This summary is based on the review of one systematic review(s)/meta-analysis(es). [1]
- Glucarpidase was associated with lower mortality in patients with severe methotrexate toxicity compared to hemodialysis, though specific mortality rates for glucarpidase were not provided, and the observational study cited had significant limitations.
- Methotrexate was moderately dialyzable by intermittent hemodialysis, but glucarpidase appeared more effective in reducing mortality, although the comparison had important limitations.
- The study noted higher mortality rates for patients with low-dose methotrexate-related toxicity (26.7%) compared to high-dose (19.5%), without attributing these outcomes to specific treatments.
- There is no safety information available in the reviewed studies.
- There is no population types or subgroups information available in the reviewed studies.
Product Monograph / Prescribing Information
| Document Title | Year | Source |
|---|---|---|
| Voraxaze (glucarpidase) Prescribing Information. | 2019 | BTG International Inc., Brentwood, TN |
Systematic Reviews / Meta-Analyses
| Document Title | Year | Source |
|---|---|---|
| Extracorporeal treatment for methotrexate poisoning systematic review and recommendations from the EXTRIP workgroup. | 2022 | Clinical Journal of the American Society of Nephrology |
Clinical Practice Guidelines
| Document Title | Year | Source |
|---|---|---|
| Incidence and management of patients with methotrexate delayed elimination in the clinical practice: A Delphi study. | 2023 | Journal of Oncology Pharmacy Practice |
| Chapter 3: Management of kidney injury caused by cancer drug therapy, from clinical practice guidelines for the management of kidney injury during anticancer drug therapy 2022. | 2023 | International Journal of Clinical Oncology |
| BTG pharmaceuticals statement on NCCN clinical practice guidelines in oncology (NCCN guidelines®) recommendation for use of glucarpidase (Voraxaze®) and MTXPK.org. | 2023 | SERB Pharmaceuticals |
| DAMPAned methotrexate: a case report and review of the management of acute methotrexate toxicity. | 2019 | Canadian Journal of Kidney Health and Disease |