Risk and consequences of chemotherapy-induced neutropenic complications in patients receiving daily filgrastim: the importance of duration of prophylaxis.

Derek Weycker,Andrew G Glass,Jason Legg,Rich Barron,Alex Kartashov,John Edelsberg

doi:10.1186/1472-6963-14-189

Abstract

BackgroundTo examine duration of daily filgrastim prophylaxis, and risk and consequences of chemotherapy-induced neutropenic complications (CINC) requiring inpatient care.MethodsUsing a retrospective cohort design and US healthcare claims data (2001–2010), we identified all cancer patients who initiated ≥1 course of myelosuppressive chemotherapy and received daily filgrastim prophylactically in ≥1 cycle. Cycles with daily filgrastim prophylaxis were pooled for analyses. CINC was identified based on hospital admissions with a diagnosis of neutropenia, fever, or infection; consequences were characterized in terms of hospital mortality, hospital length of stay (LOS), and CINC-related healthcare expenditures.ResultsRisk of CINC requiring inpatient care–adjusted for patient characteristics–was 2.4 (95% CI: 1.6-3.4) and 1.9 (1.3-2.8) times higher with 1–3 (N = 8371) and 4–6 (N = 3691) days of filgrastim prophylaxis, respectively, versus ≥7 days (N = 2226). Among subjects who developed CINC, consequences with 1–3 and 4–6 (vs. ≥7) days of filgrastim prophylaxis were: mortality (8.4% [n/N = 10/119] and 4.0% [3/75] vs. 0% [0/34]); LOS (means: 7.4 [N = 243] and 7.1 [N = 99] vs. 6.5 [N = 40]); and expenditures (means: $18,912 [N = 225] and $14,907 [N = 94] vs. $13,165 [N = 39]).ConclusionsIn this retrospective evaluation, shorter courses of daily filgrastim prophylaxis were found to be associated with an increased risk of CINC as well as poorer outcomes among those developing this condition. Because of the limitations inherent in healthcare claims databases specifically and retrospective evaluations generally, additional research addressing these limitations is needed to confirm the findings of this study.

Highlights

To examine duration of daily filgrastim prophylaxis, and risk and consequences of chemotherapy-induced neutropenic complications (CINC) requiring inpatient care
While the American Society of Clinical Oncology (ASCO) initially recommended that colony-stimulating factor (CSF) prophylaxis be administered only when FN risk is 40% or higher, in 2006, ASCO lowered the threshold to 20% based on data highlighting the importance of FN-related hospitalization as an outcome and evidence demonstrating the value of CSF prophylaxis in reducing the risk of FN, the risk of FN-related hospitalization, and the associated use of IV anti-infective agents [2,12,13]
A total of 5,477 received daily filgrastim as prophylaxis during ≥1 cycle of chemotherapy and were included in the study population; these patients contributed a total of 14,288 daily filgrastim prophylaxis patient-cycles to the analytic file

Summary

Introduction

To examine duration of daily filgrastim prophylaxis, and risk and consequences of chemotherapy-induced neutropenic complications (CINC) requiring inpatient care. While the American Society of Clinical Oncology (ASCO) initially recommended that CSF prophylaxis be administered only when FN risk is 40% or higher, in 2006, ASCO lowered the threshold to 20% based on data highlighting the importance of FN-related hospitalization as an outcome and evidence demonstrating the value of CSF prophylaxis in reducing the risk of FN, the risk of FN-related hospitalization, and the associated use of IV anti-infective agents [2,12,13]. The CSF filgrastim, which is widely used in clinical practice as prophylaxis against FN, requires daily administration during each cycle until neutrophil recovery occurs (in clinical trials, given typically for 10–11 days [and up to 14 days] until absolute neutrophil count [ANC] ≥10 × 109/L) [14,15,16,17,18,19]

Methods

Results

Discussion

Conclusion