Category: Federal Forum Posters
Purpose: Pegfilgrastim is a long acting colony stimulating factor (CSF) that is indicated to decrease the incidence of infections in patients with non-myeloid malignancies receiving myelosuppressive chemotherapy. The national comprehensive cancer network (NCCN) have provided guidelines on the appropriate use of CSF. Primary prophylaxis is recommended for the prevention of febrile neutropenia in high-risk patients. Secondary prophylaxis is recommended for patients who experienced neutropenic complication from the previous cycles. Pegfilgrastim is among the most expensive medications in the hospital formulary. Our objective is to review its current use aiming to identify areas for improvement and opportunities for cost savings.
Methods: A retrospective observational chart review for all oncology patients receiving pegfilgrastim during the study period was done over 6 month period from October 2017 to May 2018
This study was approved by the Research Ethics Committee. Patient demographics, chemotherapy protocols as well as the indication and the pattern of use of pegfilgrastim were documented. Computerized patient records were used to collect data on patient demographics. A literature review was done on the potential risk of febrile neutropenia for the chemotherapy protocols used in these patients
Results: The medical charts of 119 patients were reviewed; the majority of them had solid tumor (89%) followed by lymphoma in eleven cases, one case had CLL and one case had AML.
The intent of treatment was found to be palliative in 54 patients (45%) and it was curative in 65 patients (55%). Pegfligrastim was used as primary prophylaxis in 90 patients (75%), and as secondary prophylaxis in 29 patients (25%).
The pattern of use was reviewed according to the NCCN guidelines; the use of pegfilrastim was justified in a total number of 95 patients (80%).
Sixty six patients (55%) received it for primary prophylaxis as follows; 27 patients received regimen where the risk of f FN is more than 20%. In addition to 39 cases where the use of pegfilgrastim justified for primary prophylaxis according to patients’ risk factors including one of more of the following factors: persistent neutropenia, bone marrow involvement by tumor, recent surgery and/or open wounds, and age > 65 years receiving full chemotherapy dose intensity. More over twenty-nine patients received pegfilgrastim for secondary prophylaxis.
In 24 cases (20%) the use was not justified according to the regimen’s risk of FN and/or patient’s risk.
Conclusion: In most cases pegfilgrastim was used according to the NCCN guidelines. It is worth mentioning that in many cases, pegfilgrastim was used in patients receiving myelosuppressive chemotherapy where the intent of treatment is palliative. It is noteworthy that in those cases, considering dose reduction and/or change in the chemotherapy schedule could create an opportunity for cost saving in this subcategory of patients.
Given the substantial cost of this agent, it is important to reinforce the appropriate use as per guidelines.
Raniah Salem Alsharji– Pharmacist, seha.ae, Al Ain, United Arab Emirates