Weycker, D., Malin, J., Barron, R., Edelsberg, J., Kartashov, A., & Oster, G. (2012). Comparative effectiveness of filgrastim, pegfilgrastim, and sargramostim as prophylaxis against hospitalization for neutropenic complications in patients with cancer receiving chemotherapy. American Journal of Clinical Oncology, 35, 267–274.

The purpose of this study was to assess differences in risk of hospitalization for neutropenic complications among patients with solid tumors who received prophylactic filgrastim, pegfilgrastim, or sargramostim during their first observed course of chemotherapy from July 2001 to June 2007.

Prophylactic administration of filgrastim, pegfiltrastim, or sargramostim

• 208,401 participants
• Participants were 18–98 years old, with a mean age of 60 (filgrastim), 58 (pegfilgrastim), 61 (sargramostim), respectively.
• Males made up 53.6% of the participants; females made up 46.4%
• Cancers of the breast (female only), non-Hodgkin lymphoma, trachea, bronchus, lung, prostate, colon/rectum, Hodgkin disease, genitourinary, bone, connective tissue, and skin, with or without metastasis to bone or other sites who received filgrastim, pegfilgrastim, or sargramostim prophylaxis and/or chemotherapy cycles in which these colony-stimulating factors (CSFs) were administered as prophylaxis.
• Mean comobidity index 3.8 (pegfilgrastim), 3.7 (filgrastim), 3.6 (sargramostim)

• Multiple settings 
• Data obtained from two healthcare claims databases
• Includes patients treated nationwide in inpatient and outpatient settings

• The phase of care was active anti-tumor treatment
• Application was for elder care

Retrospective cohort study

Statistical analyses included using medical claims information from two large databases (Thomson Reuters MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits Database), calculation of duration in days of use of each CSF, independent samples t test for continuous factors and chi-square for multilevel categorical factors. Generalized estimating equations were used to assess risk of hospitalizations.

Risk of hospitalization for neutropenia was 2.1% (filgrastim prophylaxis, n = 8,286), 1.1% (pegfilgrastim prophylaxis, n = 67,247), and 2.5% (sargramostim prophylaxis, n = 1,736) and, for nuetropenia, fever, or infection for prophylactic use of filgratim, pegfilgratim, and sargramostim was 4%, 2.6%, and 2.5%, respectively. Risk of hospitalizations for all causes was 7.9%, 5.3%, and 9.6%, respectively. Adjustments were made in the statistical analysis for patient characteristics, type of cancer, and chemotherapy regimen.

Prophylactic pegfilgrastim administration is associated with less risk of hospitalizations for neutropenia/neutropenic-related complications than either prophylactic filgrastim or sargramostim in patients undergoing chemotherapy treatments for a variety of cancers.

• Retrospective study using two  healthcare claims databases.
• Data were based on insurance claims, which may not be completely accurate.
• This also does not capture individuals on insurance plans not part of these databases or the non- or underinsured (however, it likely captures a large percent of the population treated for cancer in the United States).

Recommendation of the use of prophylactic pegfilgratim may be warranted. Patient education regarding neutropenia, neutropenic-related complications, and side effects of pegfilgratim is essential. Nurse-led discussions of using pegfilgratim instead of filgratim or sargramostim with the oncology healthcare team could ensue.