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Comparative effectiveness of colony-stimulating factors for febrile neutropenia: a retrospective study.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Tan, Hiangkiat Tomic, Karen Hurley, Dana Daniel, Gregory Barron, Rich Malin, Jen
Description	Country affiliation: United States Author Affiliation: Tan H ( HealthCore, Inc., 800 Delaware Ave, 5th Floor, Wilmington, DE 19801, USA. jtan@healthcore.com)
Abstract	BACKGROUND: Granulocyte colony stimulating factors (G-CSFs) decrease the incidence of febrile neutropenia (FN) in cancer patients receiving myelosuppressive chemotherapy. There are two G-CSFs (pegfilgrastim and filgrastim) that differ in dosing schedules from which oncologists may prescribe. OBJECTIVES: This study aimed to compare the effectiveness of prophylactic pegfilgrastim and filgrastim on the risk of hospitalizations. The secondary objective was to compare the effectiveness of the timing of initiation (prophylactic versus delayed). METHODS: A retrospective study of administrative claims from US commercial payers included adult patients with Non-Hodgkin's lymphoma, breast, or lung cancer, treated with chemotherapy between July 2004 and January 2008. For these patients, the first course of chemotherapy and each unique cycle with use of G-CSF was identified and designated 'prophylaxis' if used within the first 5 days of each cycle, or 'delayed', if after day 5. The risk of neutropenia-related and all-cause hospitalization was evaluated for the pegfilgrastim and filgrastim prophylaxis cohorts and for the prophylaxis and delayed G-CSF initiation cohorts. RESULTS: Among 5,571 patient-cycles identified, 88.9% and 11.1% used pegfilgrastim and filgrastim respectively. The rate of neutropenic hospitalization was 1.1% for pegfilgrastim prophylaxis and 3.5% for filgrastim prophylaxis (P = 0.001). Compared to chemotherapy cycles with filgrastim prophylaxis, those with pegfilgrastim prophylaxis had decreased risk of neutropenia-related (adjusted odds ratio (OR) = 0.38, 95% confidence interval (CI) 0.17-0.83) and all-cause hospitalization (adjusted OR = 0.51, 95% CI 0.31-0.84). The neutropenic hospitalization rate was 1.2% for G-CSF prophylactic initiation and 3.7% for delayed G-CSF initiation (P < 0.001). Chemotherapy cycles with prophylactic initiation of either G-CSF had decreased risk of neutropenia-related (adjusted OR = 0.34, 95% CI 0.21-0.56) and all-cause hospitalization (adjusted OR = 0.67, 95% CI 0.49-0.91) compared with delayed initiation of G-CSF. CONCLUSIONS: Pegfilgrastim prescribed as prophylaxis resulted in lower risk of neutropenia-related and all-cause hospitalizations compared to filgrastim prophylaxis. This reduction was similar for prophylactic G-CSF initiation when compared to delayed G-CSF initiation.
File Format	HTM / HTML
ISSN	03007995
Issue Number	1
Volume Number	27
e-ISSN	14734877
Journal	Current Medical Research and Opinion
Language	English
Publisher	Taylor & Francis
Publisher Date	2011-01-01
Publisher Place	Great Britain (UK)
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Medicine Colony-stimulating Factors Therapeutic Use Fever Drug Therapy Neutropenia Adult Aged Antineoplastic Combined Chemotherapy Protocols Adverse Effects Female Chemically Induced Complications Filgrastim Granulocyte Colony-stimulating Factor Hospitalization Statistics & Numerical Data Humans Immunosuppressive Agents Administration & Dosage Male Middle Aged Neoplasms Recombinant Proteins Retrospective Studies Treatment Outcome Comparative Study Evaluation Studies Journal Article Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Medicine

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