Pegfilgrastim can be given to prevent chemotherapy-induced severe neutropenia, but it has not been established whether available administration techniques are comparable in efficacy. A study published in the Journal of Hematology Oncology Pharmacyset out to evaluate this.

Pegfilgrastim is usually administered subcutaneously by manual injection to stimulate production of white blood cells 24 hours after chemotherapy infusion. However, traveling back to the clinic the day after chemotherapy can be challenging for patients; a delayed-release treatment through a device marketed as Onpro®is available as an alternative to avoid the trip back to the clinic the next day. 

Based on retrospective analysis of electronic medical records from the McDowell Cancer Institute at Cleveland Clinic Akron General in Ohio, absolute neutrophil counts were compared between 2 matched patient groups (n=58 each), treated with pegfilgrastim between August 1, 2010, and November 30, 2015, either by manual injection or by Onpro device. In the Onpro group, the device was placed on the patient’s skin with drug release set for 27 hours after chemotherapy.

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Grade 4 neutropenia was found in 1 person receiving manual injection and in 3 people using the Onpro device (P=.618). Failures occurred with Onpro device in 4 patients (6.9% of the group). Four patients using Onpro required dose reductions, compared with 0 for manual injection, though this was not a statistically significant difference (P=.119).

The 2 groups did not show a statistically significant disparity in frequency of grade 4 neutropenia, leading the authors to conclude that the Onpro device was an effective and safe alternative to manual injection of pegfilgrastim and that patients could use either method. 

The authors cautioned that further studies should evaluate Onpro vs manual injection and both grades 3 and 4 neutropenia, as well as results with more patients. 


McMullen N, Porter C, Townley C. Comparing grade 4 neutropenia associated with pegfilgrastim administered via the Onpro device versus manual injection with a prefilled syringe [last modified September 24, 2018]. J Hematol Oncol Pharm Accessed October 10, 2018.