Early Discontinuation of Pegfilgrastim May Increase Risk of Febrile Neutropenia

The risk of second-cycle febrile neutropenia was significantly higher among patients who discontinued pegfilgrastim after the first cycle.
The risk of second-cycle febrile neutropenia was significantly higher among patients who discontinued pegfilgrastim after the first cycle.

The risk of second-cycle febrile neutropenia was significantly higher among patients who discontinued pegfilgrastim after the first cycle compared with those who continued prophylaxis, a new study published online ahead of print in the journal Supportive Care in Cancer has shown.1

Because previous research has demonstrated that not all cancer patients undergoing chemotherapy who receive first-cycle pegfilgrastim prophylaxis continue to receive it in subsequent cycles, researchers sought to evaluate whether patients who do not continue prophylaxis are at a higher risk for developing febrile neutropenia.

For the retrospective study, researchers analyzed data from 2245 patients who discontinued pegfilgrastim after the first cycle and matched patients who continued the drug. Patients had solid tumors or non-Hodgkin lymphoma for which they received high-risk or intermediate-risk chemotherapy regimens. Data was gathered from 2 US private health care insurance claim databases.

Results showed that 2.6% of patients who discontinued pegfilgrastim early experienced second-cycle febrile neutropenia compared with 0.8% of patients who continued prophylaxis (OR, 3.5; 95% CI: 2.0-6.0; P<.001). Subgroup analyses demonstrated similar results within cancer and regimen subgroups.

“In this retrospective evaluation of cancer chemotherapy patients who received first-cycle pegfilgrastim prophylaxis in US clinical practice, a clinically relevant minority did not receive second-cycle prophylaxis,” the investigators conclude. “Second-cycle [febrile neutropenia] odds among this subset were significantly higher than they were among those who continued prophylaxis.”

REFERENCE

1. Weycker D, Li X, Barron R, et al. Risk of chemotherapy-induced febrile neutropenia with early discontinuation of pegfilgrastim prophylaxis in US clinical practice [published online ahead of print December 15, 2015]. Supp Care Cancer. doi:10.1007/s00520-015-3039-4.

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