Clinical experience of the efficacy and safety of low-dose tolvaptan therapy in a UK tertiary oncology setting
Brabant, Georg E
Blackhall, Fiona H
Trainer, Peter J
Higham, Claire E
AffiliationDepartment of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, UK.
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AbstractContext: 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 ± 4.6 mmol/L were included. In total, 90.9% had severe hyponatremia (sNa < 125 mmol/L). Mean age was 65.1 ± 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 sNa ≥ 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, 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 over-rapid correction.
CitationChatzimavridou-Grigoriadou V, Al-Othman S, Brabant G, Kyriacou A, King J, Blackhall F, et al. Clinical Experience of the Efficacy and Safety of Low-dose Tolvaptan Therapy in a UK Tertiary Oncology Setting Vol. 106, The Journal of Clinical Endocrinology & Metabolism. The Endocrine Society; 2021. p. e4766–75.
JournalJournal of Clinical Endocrinology & Metabolism
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