Comparison of Short Acting versus Long Acting Filgrastim for Reduction of Chemotherapy Induced Febrile Neutropenia

Abstract

Introduction: Febrile neutropenia (FN) is the most frequent complications reported
during cytotoxic chemotherapy treatment. Granulocyte colony stimulating factor
(GCSF) is used to reduce neutropenia and related complications. This study
compares short versus long acting filgrastim for reduction of chemotherapy
induced FN.

Methods: 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 mcg 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.

Results: Fifty six patients were analyzed in each group. The incidence of FN
was significantly lower in pegfilgrastim group (42.90%) than filgrastim group
(69.6%), p<0.004. The mean hospital visits were 1.84±1.93 in filgrastim group
and 0.84±1.19 in pegfilgrastim group with 58.90% and 33.90% hospital admission
respectively in both groups. The mean duration of stay was 4.14±3.69 days in
filgrastim group and 2.36±3.35 days in pegfilgrastim group. The mean cost (Nepali
rupees) of filgrastim and pegfilgrastim was 20162.50+6645.37 (US$168.17±55.42)
and 32210.71±10429.43($268.67±86.99) respectively.

Conclusion: Single dose of pegfilgrastim was significantly better than multiple
doses of filgrastim for reducing FN incidence in cancer patients receiving
chemotherapy