Browse > Article

Utility Analysis for Pegfilgrastim in DLBCL Patients on R-CHOP Regimen  

Jung, Hee Won (Graduate School of Clinical Pharmacy, Sookmyung Women's University)
Kim, Jeong Mee (Department of Pharmacy, Samsung Medical Center)
Min, Myung Sook (Department of Pharmacy, Samsung Medical Center)
Lee, Young Mee (Department of Pharmacy, Samsung Medical Center)
Bang, Joon Seok (Graduate School of Clinical Pharmacy, Sookmyung Women's University)
Publication Information
Korean Journal of Clinical Pharmacy / v.25, no.3, 2015 , pp. 151-158 More about this Journal
Abstract
Objective: This study was designed to compare pegfilgrastim and filgrastim in diffuse large B-cell lymphoma (DLBCL) patients treated with a rituximab with cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone (R-CHOP) regimen in terms of clinical efficacy and cost-effectiveness. Method: Clinical efficacy was measured by trough level of absolute neutrophil count (ANC), days of ANC under 50% of baseline value, days of ANC under 90% of baseline value, duration of ANC recovery to baseline value, days of ANC less than $0.5{\times}10^9cells/L$, and difference of peak and trough level of ANC during 1 cycle of R-CHOP regimen. To evaluate cost-effectiveness, total prices of used filgrastim and pegfilgrastim within 1 cycle of R-CHOP were analyzed. Results: In terms of clinical efficacy, trough level of ANC and days to ANC recovery showed statistical significance. The median trough levels of ANC with administration of filgrastim and pegfilgrastim were 0.18 and 1.94 (p = 0.021), respectively, and the median durations of ANC recovery to baseline value were 5.5 days and 2 days (p = 0.023), respectively. For the median days of ANC under 50% of baseline value, days of ANC under 90% of baseline value, days of ANC less than $0.5{\times}10^9cells/L$, and difference of peak and trough level of ANC during 1 cycle of R-CHOP, the pegfilgrastim group performed better than the filgrastim group. However the difference was not statistically significant. In terms of overall expense during 1 cycle of R-CHOP, pegfilgrastim is about 3.43 times more expensive than filgrastim. Conclusion: Pegfilgrastim is more efficient than filgrastim in terms of clinical efficacy. In terms of prices, pegfilgrastim is more expensive than filgrastim for patients, but it is more convenient in clinical use. Therefore, pegfilgrastim should be the preferred choice of G-CSF for neutropenic patients. Further comparative study of pegfilgrastim and filgrastim is needed.
Keywords
pegfilgrastim; filgrastim; DLBCL; R-CHOP; neutropenia; ANC; efficacy; price;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Hollingshead LM, Goa KL. Recombinant granulocyte colony-stimulating factor (rG-CSF): a review of its pharmacological properties and prospective role in neutropenic conditions. Drugs 1991;42:300-30.   DOI
2 Grigg A, Solal-Celigny P, Hoskin P, et al. Open-label, randomized study of pegfilgrastim vs. daily filgrastim as an adjunct to chemotherapy in elderly patients with non-Hodgkin's lymphoma. Leuk Lymphoma 2003;44(9):1503-8.   DOI
3 Green MD, Koelbl H, Baselga J, et al. A randomized double-blind multicenter phase III study of fixed-dose single-administration pegfilgrastim versus daily filgrastim in patients receiving myelosuppressive chemotherapy. Ann Oncol 2003;14(1):29-35.   DOI
4 Balducci L, Al-Halawani H, Charu V, et al. Elderly cancer patients receiving chemotherapy benefit from first-cycle pegfilgrastim. Oncologist 2007;12(12):1416-24.   DOI
5 Lathia N, Isogai PK, De Angelis C, et al. Cost-effectiveness of filgrastim and pegfilgrastim as primary prophylaxis against febrile neutropenia in lymphoma patients. J Natl Cancer Inst 2013;105(15):1078-85.   DOI
6 Crawford J, Dale DC, Lyman GH. Chemotherapy-induced neutropenia: risks, consequences, and new directions for its management. Cancer 2004;100(2):228-37.   DOI
7 Author affiliations from The Non-Hodgkin's Lymphoma Classification Project. A clinical evaluation of the International Lymphoma Study Group classification of non-Hodgkin's lymphoma. Blood 1997;89(11):3909-18.
8 Morton LM, Wang SS, Devesa SS, et al. Lymphoma incidence patterns by WHO subtype in the United States 1992-2001. Blood 2006;107(1):265-76.   DOI
9 Smith A, Howell D, Patmore R, et al. Incidence of haematological malignancy by sub-type: A report from the Haematological Malignancy Research Network. Br J Cancer 2011;105(11):1684-92.   DOI
10 Freeman AS, Aster JC. (2012) Epidemiology, clinical manifestations, pathologic features, and diagnosis of diffuse large B cell lymphoma. In basow, Denise S. UpToDate: (http://www.uptodate.com/contents/epidemiology-clinical-manifestations-pathologic-features-and-diagnosis-of-diffuse-large-b-cell-lymphoma)
11 Feugier P, Van Hoof A, Sebban C, et al. Long-term results of the RCHOP study in the treatment of elderly patients with diffuse large Bcell lymphoma: a study by the Groupe d'Etude des Lymphomes de l'Adulte. J Clin Oncol 2005;23(18):4117-26.   DOI
12 Coiffier B, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med 2002;346(4):235-42.   DOI
13 Trillet-Lenoir V, Green J, Manegold C, et al. Recombinant granulocyte colony stimulating factor reduces the infectious complications of cytotoxic chemotherapy. Eur J Cancer 1993;29(3):319-24.   DOI
14 Bennett CL, Djulbegovic B, Norris LB, et al. Colony-stimulating factors for febrile neutropenia during cancer therapy. N Engl J Med 2013;368(12):1131-9.   DOI
15 McEvoy G. AHFS Drug Information. 2012.
16 Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 Published May 28, 2009 by National Cancer Institute (http://www.hrc.govt.nz/sites/default/files/CTCAE%20manual%20-%20DMCC.pdf)
17 Health Insurance Review & Assessment Service www.hira.or.kr; (Accessed on October 2014).
18 Amgen. NEUPOGEN (filgrastim) Prescribing Information. http://www.amgen.com; (Accessed on October 2014).