Chemotherapy-induced neutropenia is a frequent complication of cytotoxic chemotherapy treatment. It increases the risk of infection and often leads to febrile neutropenia (FN). Development of FN may compromise the treatment response with substantial economic burden. Granulocyte colony-stimulating factor (GCSF) administration could prevent episodes of FN and its related complications. Filgrastim and pegfilgrastim are GCSFs approved for the reduction of neutropenia-related outcomes. This study compares filgrastim and pegfilgrastim as primary prevention for reduction of chemotherapy induced FN and its direct cost to the patients.
Histologically confirmed solid cancer patients (n=112) receiving either high-risk or intermediate-risk chemotherapy regimens for FN were randomized into two groups. Group one received filgrastim 300 μg subcutaneously for five days and group two received pegfilgrastim 6 mg subcutaneously single dose, starting after 24 hours after completion of chemotherapy during each chemotherapy cycle. The primary end point was the occurrence of FN. The secondary end points were number of hospital visits, duration of hospital stay and total direct costs of filgrastim and pegfilgrastim.
Fifty six patients were analyzed in each group. The incidence of FN was significantly lower in the pegfilgrastim group (42.90%) than in the filgrastim group (69.6%), p<0.004. The mean number of hospital visits were 1.84+1.93 in the filgrastim group and 0.84+1.19 in the pegfilgrastim group with 58.90% and 33.90% hospital admission, respectivelys. The mean duration of stay was 4.1429+3.69 days in the filgrastim group and 2.36+3.35 days in the pegfilgrastim group. The total mean cost (Nepali rupees) of filgrastim and pegfilgrastim was 20162.50+6645.37 and 32210.71+10429.43, respectively.
A single dose of pegfilgrastim is better than multiple doses of filgrastim in reducing FN incidence which minimizes hospital stay, visits and frequency of admission in cancer patients receiving chemotherapy. Taken together, the adequate evaluation of patients and the use of prophylactic GCSFs become relevant for optimizing clinical outcomes and reducing hospitalization related morbidities in the management of FN.
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