Use and effectiveness of pegfilgrastim prophylaxis in US clinical practice:a retrospective observational study

Weycker, Derek; Doroff, Robin; Hanau, Ahuva; Bowers, Charles; Belani, Rajesh; Chandler, David; Lonshteyn, Alexander; Bensink, Mark; Lyman, Gary H.

doi:10.1186/s12885-019-6010-9

Cited by 17 publications

(11 citation statements)

References 48 publications

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“…Among women with breast cancer receiving a low-risk regimen (AC: doxorubicin þ cyclophosphamide [conventional-dose]), however, no such benefits were reported. One other recent study, which comprised separate analyses of commercially insured patients and Medicare patients, respectively, documented the effectiveness of pegfilgrastim prophylaxis among patients with non-metastatic breast cancer or NHL receiving chemotherapy with an intermediate/high-risk for FN 79 . In the first analysis, which utilized data from two large private healthcare claims databases (2010-2016), FN odds in cycle 1 were significantly higher among patients not receiving prophylaxis versus those receiving pegfilgrastim prophylaxis (FN broad definition: OR ¼ 2.6, 95% CI 2.3-2.8; FN narrow definition: OR ¼ 4.2, 95% CI 3.8-4.7).…”

Section: Use Of Pegfilgrastim In Us Clinical Practicementioning

confidence: 99%

Prophylaxis of febrile neutropenia with colony-stimulating factors: the first 25 years

Edelsberg

Weycker

Bensink

et al. 2019

Current Medical Research and Opinion

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Filgrastim prophylaxis, both primary and secondary, was rapidly incorporated into clinical practice in the 1990s. When pegfilgrastim became available in 2002, it quickly replaced filgrastim as the colonystimulating factor (CSF) of choice for prophylaxis. Use of prophylaxis increased markedly in the first decade of this century and has stabilized during the present decade. Data concerning real-world CSF prophylactic practice patterns are limited but suggest that both primary and secondary prophylaxis are common, and that use is frequently inappropriate according to guidelines. The extent of inappropriate use is controversial, as are issues concerning the cost-effectiveness of prophylaxis versus no prophylaxis and the cost-effectiveness of primary prophylaxis versus secondary prophylaxis. Nevertheless, CSF prophylaxis is firmly established as a valuable adjunct to chemotherapy and will almost certainly continue to be widely used for the foreseeable future. In this article, we chronicle the use and impact of CSF prophylaxis in US patients receiving myelosuppressive chemotherapy for nonmyeloid malignancies. We emphasize the interplay of expert opinion, clinical evidence, and economic factors in shaping the use of CSFs in clinical practice over time, and, with the recent introduction of new CSF agents and options, we aim to provide useful clinical and economic information for healthcare decision makers. ARTICLE HISTORY

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Section: Use Of Pegfilgrastim In Us Clinical Practicementioning

confidence: 99%

Prophylaxis of febrile neutropenia with colony-stimulating factors: the first 25 years

Edelsberg

Weycker

Bensink

et al. 2019

Current Medical Research and Opinion

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“…G-CSFs increase the production (i.e., differentiation and proliferation) and activity of neutrophils, which improve immune defense against infection and reduce the risk of FN [12][13][14]. Despite available evidence that prophylactic G-CSF is associated with a lower risk of FN, sustained chemotherapy dose intensity, and reduced mortality [15], several studies have reported that many patients for whom prophylaxis is recommended do not receive it in US clinical practice [15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Risk of chemotherapy-induced febrile neutropenia in patients with metastatic cancer not receiving granulocyte colony-stimulating factor prophylaxis in US clinical practice

Averin

Silvia

Lamerato

et al. 2020

Support Care Cancer

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Objectives To evaluate the use of granulocyte colony-stimulating factor (G-CSF) prophylaxis in US patients with selected metastatic cancers and chemotherapy-induced febrile neutropenia (FN) incidence and associated outcomes among the subgroup who did not receive prophylaxis. Methods This retrospective cohort study was conducted at four US health systems and included adults with metastatic cancer (breast, colorectal, lung, non-Hodgkin lymphoma [NHL]) who received myelosuppressive chemotherapy (2009–2017). Patients were stratified by FN risk level based on risk factors and chemotherapy (low/unclassified risk, intermediate risk without any risk factors, intermediate risk with ≥ 1 risk factor [IR + 1], high risk [HR]). G-CSF use was evaluated among all patients stratified by FN risk, and FN/FN-related outcomes were evaluated among patients who did not receive first-cycle G-CSF prophylaxis. Results Among 1457 metastatic cancer patients, 20.5% and 28.1% were classified as HR and IR + 1, respectively. First-cycle G-CSF prophylaxis use was 48.5% among HR patients and 13.9% among IR + 1 patients. In the subgroup not receiving first-cycle G-CSF prophylaxis, FN incidence in cycle 1 was 7.8% for HR patients and 4.8% for IR + 1 patients; during the course, corresponding values were 16.9% and 15.9%. Most (> 90%) FN episodes required hospitalization, and mortality risk ranged from 7.1 to 26.9% across subgroups. Conclusion In this retrospective study, the majority of metastatic cancer chemotherapy patients for whom G-CSF prophylaxis is recommended did not receive it; FN incidence in this subgroup was notably high. Patients with elevated FN risk should be carefully identified and managed to ensure appropriate use of supportive care.

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“…The prophylactic effect of pegfilgrastim has not been fully evaluated throughout the cycles of standard R-CHOP in DLBCL patients as previous studies included heterogeneous disease groups (NHLs), diverse regimens (CHOP, R-CHOP, and others), use of pegfilgrastim only in the first cycle, or mixed use of G-CSF or pegfilgrastim [9,10,[22][23][24]. In real-world practice, primary prophylaxis is not fully performed [13]. As pegfilgrastim prophylaxis has been available in Korea since 2014, we were able to compare the incidence of FN and treatment outcomes of DLBCL patients treated with R-CHOP between two cohorts collected during different time periods.…”

Section: Discussionmentioning

confidence: 99%

Section: A C C E P T E D a R T I C L Ementioning

confidence: 99%

Pegfilgrastim Prophylaxis Is Effective in the Prevention of Febrile Neutropenia and Reduces Mortality in Patients Aged ≥ 75 Years with Diffuse Large B-Cell Lymphoma Treated with R-CHOP: A Prospective Cohort Study

et al. 2022

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Febrile neutropenia (FN) can cause suboptimal treatment and treatment-related mortality (TRM) in diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). Materials and methodsWe conducted a prospective cohort study to evaluate the effectiveness of pegfilgrastim prophylaxis in DLBCL patients receiving R-CHOP, and we compared them with the PROCESS cohort (n=485). ResultsSince January 2015, 986 patients with DLBCL were enrolled. Pegfilgrastim was administered at least once in 930 patients (94.3%), covering 90.3% of all cycles. FN developed in 137 patients (13.9%) in this cohort (23.7% in the PROCESS cohort, p<0.001), and 4.2% of all cycles (10.2% in the PROCESS cohort, p<0.001). Dose delay was less common (≥3 days: 18.1% vs. 23.7%, p=0.015; ≥5 days: 12.0% vs. 18.3%, p=0.023) in this cohort than in the PROCESS cohort. The incidence of TRM (3.2% vs. 5.6%, p=0.047) and infection-related death (1.8% vs. 4.5%, p=0.004) was lower in this cohort than in the PROCESS cohort. The 4-year overall survival (OS) and progression-free survival (PFS) rates of the two cohorts were not different (OS: 73.0% vs. 71.9%, p=0.545; PFS: 69.5% vs. 68.8%, p=0.616). However, in patients aged ≥75 years, the 4-year OS and PFS rates were higher in this cohort than in the PROCESS cohort (OS: 49.6% vs. 33.7%, p=0.032; PFS: 44.2% vs. 30.3% p=0.047). ConclusionPegfilgrastim prophylaxis is effective in the prevention of FN and infection-related death in DLBCL patients receiving R-CHOP, and it also improves OS in patients aged ≥75 years.

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Use and effectiveness of pegfilgrastim prophylaxis in US clinical practice:a retrospective observational study

Cited by 17 publications

References 48 publications

Prophylaxis of febrile neutropenia with colony-stimulating factors: the first 25 years

Prophylaxis of febrile neutropenia with colony-stimulating factors: the first 25 years

Risk of chemotherapy-induced febrile neutropenia in patients with metastatic cancer not receiving granulocyte colony-stimulating factor prophylaxis in US clinical practice

Pegfilgrastim Prophylaxis Is Effective in the Prevention of Febrile Neutropenia and Reduces Mortality in Patients Aged ≥ 75 Years with Diffuse Large B-Cell Lymphoma Treated with R-CHOP: A Prospective Cohort Study

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