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Neulasta vs Neupogen
Introduction
For patients undergoing chemotherapy, certain drugs that stimulate the production of white blood cells can help in combating infection risks and managing symptoms. Neulasta (pegfilgrastim) and Neupogen (filgrastim) are two such drugs that are prescribed for this purpose. They each impact different aspects of white blood cell proliferation, but both have significant effects in reducing neutropenia, a condition characterized by low levels of neutrophils - a type of white blood cell essential for fighting off bacterial infections. Neulasta is a PEGylated form of filgrastim which allows it to stay in the body longer compared to its counterpart Neupogen. Hence, it's often administered less frequently than Neupogen — typically once per chemotherapy cycle versus daily injections with Neupogen.
What is Neulasta?
Pegfilgrastim (the generic name for Neulasta) and Filgrastim (known as Neupogen) are two different drugs developed to stimulate the production of white blood cells in patients undergoing chemotherapy. Pegfilgrastim, approved by the FDA in 2002, is a long-acting version of Filgrastim and requires fewer injections due to its sustained release mechanism. It works by promoting bone marrow activity which results in increased levels of infection-fighting white blood cells within the body. This reduction in injection frequency is often seen as an advantage over filgrastim, especially for patients who may have difficulty with self-injection or frequent healthcare visits. However, both medicines have been shown effective at reducing neutropenia-related complications with similar side effect profiles including bone pain and fatigue.
What conditions is Neulasta approved to treat?
Neulasta and Neupogen are both used to prevent neutropenia, a condition characterized by abnormally low levels of neutrophils, which are a type of white blood cell essential for fighting off infections. Specifically:
- Neulasta (pegfilgrastim) is approved for use in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a significant incidence of severe neutropenia with fever.
- Neupogen (filgrastim) has broader applications; it's not only used to reduce the chance of infection due to low white blood cells in people who have certain types of cancers and are receiving chemotherapy but also in those who are undergoing bone marrow transplants or undergoing peripheral blood progenitor cell collection and therapy.
How does Neulasta help with these illnesses?
Neulasta aids in managing neutropenia, a condition characterized by a low level of white blood cells, specifically neutrophils. It achieves this by stimulating the bone marrow to produce more white blood cells. Neulasta is a longer-acting version of the drug filgrastim (marketed as Neupogen) and functions through binding with granulocyte colony-stimulating factor (G-CSF) receptor which initiates cell proliferation and differentiation processes producing more white blood cells. This mechanism helps in maintaining higher levels of white blood cells for extended periods.
White blood cells play an essential role in our body's defense system against infections; hence individuals with lower levels are at an increased risk for severe infections. By increasing their production, both Neulasta and Neupogen can limit the negative effects associated with neutropenia and aid patients in effectively mitigating their vulnerability to infection. However, due to its prolonged effect, Neulasta often requires fewer injections than Neupogen making it a preferred choice among many healthcare providers.
What is Neupogen?
Neupogen, also known as Filgrastim, is a granulocyte colony-stimulating factor (G-CSF) analog used to stimulate the proliferation and differentiation of granulocytes. It works by stimulating bone marrow to produce more neutrophils (a type of white blood cell), which are essential for fighting off infections in the body. Neupogen was first approved by the FDA in 1991 and it quickly became an important tool in helping cancer patients undergoing chemotherapy maintain their immune system.
Unlike its counterpart Neulasta, which is administered once per chemotherapy cycle due to its longer-lasting effects, Neupogen usually requires daily injections. However, this can provide a level of flexibility that might be beneficial in certain treatment plans or patient circumstances. Furthermore, because it does not remain active within the body as long as Neulasta does, there may be less risk of certain side effects such as bone pain.
What conditions is Neupogen approved to treat?
Neupogen is an FDA-approved drug used to treat a variety of conditions including:
- Neutropenia, a condition characterized by low levels of neutrophils in the blood which can occur after receiving cancer treatment.
- Severe chronic neutropenia (SCN), a rare disorder that causes abnormally low levels of certain white blood cells.
- Neutropenia in patients with Acute Myeloid Leukemia (AML).
How does Neupogen help with these illnesses?
Granulocyte colony-stimulating factor (G-CSF) is a glycoprotein that stimulates the bone marrow to produce granulocytes and stem cells, then releases them into the blood. Neupogen, also known as filgrastim, works by mimicking the effects of G-CSF in order to help stimulate growth and promote survival of neutrophil precursor cells. This addresses low white blood cell counts or neutropenia, which can result from certain types of chemotherapy treatment.
Neupogen has been instrumental in managing patients undergoing myelosuppressive therapies where there's an increased risk for infection due to a suppressed immune system. Its function is similar to that of Neulasta (pegfilgrastim), but it requires more frequent dosing since it does not stay as long in the body compared to its counterpart. Therefore Neupogen may be preferred for shorter treatment periods or when closer monitoring is necessary.
How effective are both Neulasta and Neupogen?
Both pegfilgrastim (Neulasta) and filgrastim (Neupogen) have established histories of success in treating patients with neutropenia, often as a side effect of chemotherapy. They were initially approved by the FDA within 10 years of each other. Since they act on different mechanisms within the body, they may be prescribed under different circumstances.
The effectiveness of Neulasta and Neupogen in alleviating neutropenia was directly studied in numerous clinical trials; both drugs exhibited similar efficacy for managing symptoms and preventing potentially lethal infections due to low white blood cell counts. In these studies, none of the outcomes differed significantly between patients receiving Neupogen or those receiving Neulasta.
A review published in 2015 demonstrated that pegfilgrastim is effective at reducing febrile neutropenia starting from its first administration following chemotherapy treatment. The study also reported that it has an excellent safety profile and is well-tolerated among cancer populations undergoing myelosuppressive therapy.
In contrast, a meta-analysis conducted in 2018 indicated that while filgrastim effectively reduces infection-related mortality when administered after chemotherapy, it tends to require more frequent dosing compared to pegfilgrastim due to its shorter half-life.
While both treatments are effective at reducing the risk of infection following chemotherapy-induced neutropenia, one key difference lies in their dosing schedules: While filgrastim must be administered daily until recovery from neutropenia is achieved—typically over several days—pegfilgrastim requires only one injection per cycle due to its longer duration of action brought about by PEGylation technology—a process which slows down drug clearance thereby increasing duration of action. This makes pegfilgrastrim more convenient for many patients.
Nonetheless, given their slightly different pharmacokinetic profiles along with cost considerations—the price tag on Neulasta can be somewhat steep—it's important for doctors and patients alike to take individual patient factors into account when choosing between these two treatments options.
At what dose is Neulasta typically prescribed?
Dosages of Neulasta are typically administered as a single 6 mg subcutaneous injection per chemotherapy cycle, with the drug intended to stimulate white blood cell production following chemotherapy. It's generally given at least 24 hours after the administration of cytotoxic chemotherapy. On the other hand, Neupogen is usually prescribed at 5-10 mcg/kg/day as a subcutaneous injection for up to two weeks until the neutrophil count returns to normal range post-chemotherapy. The dosage can be adjusted every few days based on patient response and should not exceed 10 mcg/kg/day in most cases.
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At what dose is Neupogen typically prescribed?
Neupogen treatment typically begins with a dosage of 5 mcg/kg per day, administered as a subcutaneous injection or an intravenous infusion. The dose can then be increased based on the patient's body weight and absolute neutrophil count (ANC), often divided into daily doses. Maximum daily dose varies depending on the specific condition treated but must always be adjusted under medical supervision to ensure safety and efficacy. If there is no response after increasing the Neupogen dosage over a sufficient period, further diagnostic evaluation may be warranted.
What are the most common side effects for Neulasta?
Side effects of Neulasta and Neupogen mainly center around their role in stimulating white blood cell growth. Common side effects include:
- Bone pain
- Pain in your arms or legs
- Headache, tiredness
- Nausea, upset stomach
- Dizziness
- Skin rash, hair loss
Rare but serious side effects can also occur including:
- Difficulty breathing, wheezing
- Swelling of the face or throat
-Sudden severe fatigue or weakness
-Bloody stools or unusually heavy menstrual periods
If you experience any severe symptoms while on either Neulasta or Neupogen, seek immediate medical attention. It's important to note that everyone's reaction to medication is unique; always discuss potential risks with your healthcare provider.
Are there any potential serious side effects for Neulasta?
While Neulasta and Neupogen have similar mechanisms of action, some patients might experience different side effects. Some serious potential side effects include:
- An allergic reaction: symptoms can include hives, difficulty breathing or swallowing, swelling in your face or throat.
- Severe skin reactions: these can involve fever, sore throat, burning eyes, skin pain and a red or purple skin rash that blisters and peels.
- Capillary Leak Syndrome: this includes a sudden drop in blood pressure causing dizziness (like you might pass out), shortness of breath; fast heartbeats; swelling in your limbs; changes in color of your arms/legs due to poor circulation.
- Sickle cell Crisis: those with sickle cell disorder could undergo severe pain episodes triggered by the medication.
- Kidney injury - signs may include lower amounts of urine being passed or cloudy/bloody urine.
Should any individual suffer from these symptoms while on either drug they should seek immediate medical attention. These medications also carry risk for bone/throat/muscle ache but these are more common less severe side effects. Always consult with healthcare professionals about risks when starting new treatments.
What are the most common side effects for Neupogen?
Neupogen, like any medication, may cause a range of side effects:
- Mild to severe bone pain
- Headaches or dizziness
- Alterations in blood counts which could lead to increased bleeding and bruising
- Nausea and vomiting
- Diarrhea or constipation
- Fatigue or insomnia
- Hair loss
- Skin rash or itching
- Swelling of the hands, feet, ankles, or lower legs due to fluid retention.
It's important to note that while these side effects can occur with Neupogen use, they do not happen in all individuals taking the drug. Always consult with your healthcare provider for more detailed information tailored specifically to you.
Are there any potential serious side effects for Neupogen?
While Neupogen is generally well-tolerated, in certain circumstances it may cause severe side effects. These include:
- Signs of an allergic reaction such as hives, difficulty breathing, swelling in your face or throat
- Sudden and severe lung problems; symptoms can include trouble breathing, fever, and a cough that doesn't go away
- A condition called "Capillary Leak Syndrome" that can lead to death if not treated. Symptoms may include a decrease in blood pressure, sudden weight gain, feeling tired or weak.
- Kidney injury (glomerulonephritis). Symptoms of this could be puffiness in your face or ankles; blood in your urine or brown-colored urine; pain on the side of your stomach (abdomen); or you feel less hungry than usual.
If you experience any of these symptoms while taking Neupogen, call your healthcare provider right away.
Contraindications for Neulasta and Neupogen?
Both Neulasta and Neupogen, much like other medications stimulating white blood cell growth, may induce bone pain or allergic reactions in some people. Should you notice any sharp discomfort or an escalation of allergic symptoms, please seek immediate medical attention.
Neither Neulasta nor Neupogen should be administered if you are receiving chemotherapy drugs that have a long-lasting effect on your blood cells. Always inform your healthcare provider about all the medications you are taking; certain chemotherapy drugs might require a period to clear from the system to avoid dangerous interactions with Neulasta and Neupogen.
Furthermore, these medications must not be taken within 14 days prior to and 24 hours after cancer treatment as they can interfere with the effectiveness of the therapy.
How much do Neulasta and Neupogen cost?
For the brand name versions of these drugs:
- The price of 1 pre-filled syringe of Neulasta (6 mg) averages around $7,000–$8,000. Since it's typically given once per chemotherapy cycle (every 21 days or so), this works out to approximately $332–$380/day.
- The price for 10 vials of Neupogen (300 mcg each) is about $3,200. Depending on your dose and how often you need it (usually daily for up to two weeks), this could work out to between $114 and $320/day.
Thus, if you are using a lower dose range or fewer doses overall with Neupogen, then Neulasta would be more expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.
As far as we know currently there are no generic forms available for either drug in the United States; however, biosimilars exist that may offer similar efficacy at potentially reduced costs:
- Fulphila is offered as an alternative to Neulasta with prices averaging around $4,500 - $5,000 per injection.
- Zarxio can serve as an alternative to Neupogen and ranges from roughly $275 - $350 per injection depending on dosage strength.
Popularity of Neulasta and Neupogen
Pegfilgrastim, sold under the brand name Neulasta, was prescribed to just over 1.6 million patients in the US in 2020. This bioengineered drug is used to stimulate bone marrow to produce more white blood cells, helping cancer patients withstand chemotherapy's impact on their immune system. It accounts for roughly 40% of prescriptions within its therapeutic class called granulocyte colony-stimulating factors (G-CSFs). Its popularity can be attributed to its longer duration of action and less frequent dosing compared to other G-CSFs.
Filgrastim, also known as Neupogen, was prescribed nearly 900 thousand times during the same year. It accounted for about a fifth of prescriptions among G-CSFs drugs and has remained relatively steady in terms of usage over the past decade. Despite being an older medication than pegfilgrastim, it still plays a significant role due to its lower cost and flexibility with dosing schedules depending on patient needs.
Conclusion
Both Neulasta (pegfilgrastim) and Neupogen (filgrastim) are used to stimulate the production of white blood cells in patients undergoing cancer treatments such as chemotherapy that can lower levels of these crucial immune system components. They have a long-standing record of effectiveness, backed by numerous clinical studies indicating they outperform placebo treatments. Their primary difference lies in their frequency of administration; Neulasta is a longer-acting drug requiring only one injection per chemotherapy cycle while Neupogen typically requires daily injections.
Neulasta, due to its less frequent dosing schedule, is often favored for convenience. However, this must be balanced against considerations like cost and patient-specific factors; it tends to be more expensive than Neupogen but both are available in generic form which could mean significant savings for patients paying out-of-pocket.
The side effect profiles between the two drugs are generally similar with bone pain being a common side effect from both medications due to their stimulatory effects on the bone marrow where new blood cells originate. Both drugs require monitoring from healthcare providers particularly at initiation or when changes in dosage occur – although they stimulate immunity by increasing white blood cell count, there's also an increased risk for spleen rupture and severe respiratory problems among other potential complications.