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How Will My Doctor Decide Whether I Need Pegfilgrastim Versus Filgrastim?

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Updated November 28, 2011

Question: How Will My Doctor Decide Whether I Need Pegfilgrastim Versus Filgrastim?
Chemotherapy can cause your neutrophil counts to drop, which puts you at risk of infection. Neutropenia is treated with Neulasta or Neupogen, but what's the difference, and how does your doctor choose between them?
Answer: How are Neulasta and Neupogen Different?
Neulasta and Neupogen are both made of a natural protein known as granulocyte-colony stimulating factor (or "G-CSF"). Pegfilgrastim (Neulasta) has a polyethylene glycol, "PEG," unit added to it, which makes the molecule larger, so that it stays in your system longer than filgrastim (Neupogen).

How Many Injections per Chemo Cycle Do I Need?
Neulasta is given once for each cycle of high-dose chemotherapy, at least 24 hours after chemo, and no sooner than 14 days before your next chemo infusion. Neupogen is given in several injections on a daily basis, until your neutrophil counts come back to normal levels. You may need just three or four shots of Neupogen, or as many as 10, depending on how well your system responds to the drug.

Effectiveness Is Comparable
In clinical trials, both drugs compared favorably as to:

  • Effectiveness in boosting neutrophil production
  • Tolerability by patients
  • Safety of use
Side Effects Are Almost the Same
Bone pain is the most common side effect for both drugs.
  • Neulasta – 31% to 26% of all patients
  • Neupogen – 24% of all patients
Cost Per Injection
One 6 mg Neulasta injection will cost between $3,000 to $7000, depending on the supplier. One 300 microgram Neupogen injection will cost between $285 to $300.
One 6 mg injection of Neulasta costs about the same as 10.4 300 microgram injections of Neupogen.

Will My Insurance Cover the Cost?
Not every health insurance plan that offers prescription drug benefits will cover the cost of Neulasta. Before you start chemotherapy, ask your oncologist if you may need Neupogen or Neulasta. You will be asked to sign a form that obliges you to cover the cost of these drugs if your insurance won't pay for it. If you don't know whether your insurance covers Neupogen or Neulasta, phone the company before you begin chemotherapy to find out their coverage policy. They may help with the cost of Neupogen, but not Neulasta. You can still receive treatment, but you may have to stick with Neupogen (more injections) if your insurance won't cover Neulasta.

How Is This Decision Made?
The decision to use Neulasta or Neupogen is driven by medical necessity. These drugs are not just "icing on the cake" or a little something extra; when you have neutrapenia, you must be treated for it. Ask your doctor to help advocate on your behalf, if your insurance company doesn't agree to cover any drug that you need.

Weekly Chemo and Neupogen
If you are having weekly, low-dose chemotherapy, Neulasta is not an option. Since Neulasta must be given 24 hours after chemo, and 14 days before the next cycle, it won't work with weekly infusions. Neupogen will work fine with weekly chemo, since it clears your system fairly quickly, and can be given as often as you need it between chemo cycles.

Save on Administrative, Copayments, and Transportation Costs
If you're having weekly chemo and need frequent Neupogen shots, you can save in several ways. Ask your nurse if you can take Neupogen shots at home, and if so, have them train you or a family member on the proper way to give the injection. Be sure to carefully follow the instructions for storage, preparation, and injection. This will save you administrative costs, as well as copayments for each office visit, and transportation costs related to each shot. You will still have to visit your clinic for a regular CBC, to check your blood counts, with special attention to your neutrophil levels.

Sources:

IngentaConnect. Comparison of pegfilgrastim with filgrastim on febrile neutropenia, grade IV neutropenia and bone pain: a meta-analysis of randomized controlled trials. Published by LibraPharm. Volume 23, Number 9, September 2007 , pp. 2283-2295(13).

Cigna.com. Granulocyte Colony Stimulating Factor Therapy [Filgrastim (Neupogen®), Pegfilgrastim (Neulasta®)]. PDF file. Revised Date: 4/15/2007.

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