- Center on Health Equity & Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
On-Body Injector as Effective as Manual Injection of Pegfilgrastim for Preventing Febrile Neutropenia
In 2015, the Neulasta On-Body Injector (OBI) Onpro device was introduced as a less costly method of pegfilgrastim administration. While the device has been found to be safe in healthy volunteers and have pharmacokinetics similar to that of traditional pegfilgrastim, there have been limited data comparing the 2 methods.
Typically, granulocyte colony-stimulating factor is given 24 hours after chemotherapy to reduce the risk of febrile neutropenia in patients with cancer. But, for patients who are underinsured and don’t have coverage for home injections, this involves a second trip to the clinic. In 2015, the Neulasta On-Body Injector (OBI) Onpro device was introduced as a less costly method of pegfilgrastim (Neulasta) administration. The device is attached to the patient’s arm and timed to automatically deliver an injection 27 hours after application, allowing the patient to avoid another clinic visit.
While the device has been found to be safe in healthy volunteers and have pharmacokinetics similar to that of traditional pegfilgrastim, there have been limited data comparing the 2 methods. According to a study presented at the 60th American Society of Hematology Annual Meeting & Exposition, the device is as effective as manual injection of pegfilgrastim in preventing febrile neutropenia.
Between May 1, 2016, and May 30, 2017, the researchers reviewed the use of the 2 pegfilgrastim delivery systems among 120 patients at a large urban cancer center. Half of the patients returned to the clinic a day after chemotherapy for manual injection while the other half went home and used the OBI device.
All patients were receiving high-risk chemotherapy regimens, and the average age ranged from 55.6 to 56.1 years between the 2 groups.
During the period, 17 (14%) of the patients developed febrile neutropenia, with 16.7% of those receiving manual injection of pegfilgrastim developing the condition and 8.3% of those using the OBI device developing the condition.
“There was a non-significant increase in febrile neutropenia in the manual injection group but this may have been due to a significant imbalance of more myelosuppressive non-Hodgkin lymphoma regimens,” explained the researchers. While 11.7% of patients in the OBI device group had non-Hodgkin lymphoma, 38.3% of patients in the manual injection group had the disease.
Among the patients who developed febrile neutropenia, nadir absolute neutrophil count, on average, was 160 for the manual injection group compared with 432 in the OBI device group.
All patients who developed febrile neutropenia were admitted for inpatient care and treated with intravenous antibiotics, with average length of stay being 6.6 days for the manual injection group compared with 4.4 days for the OBI device group.
Among the patients using the OBI device, 3 (5%) reported that the injector fell off after attachment.
“Overall, in patients exposed to high-risk chemotherapy, OBI use resulted in a low incidence of febrile neutropenia and fewer return clinic visits, but education on handling device failure is vital to the effectiveness of the pegfilgrastim OBI in this patient population,” noted the researchers.
Reference
Jindal A, Kover J, Raduka V, O'Brien T. Incidence of neutropenic fever at a safety net hospital in cancer chemotherapy patients receiving prophylactic pegfilgrastim manual injection compared to the on-body auto-injector. Presented at: 60th American Society of Hematology Annual Meeting & Exposition; December 1, 2018; San Diego, CA. Abstract 4709.
The Long-term Social Value of Granulocyte Colony-Stimulating Factors
October 4th 2019Although currently underutilized, granulocyte colony-stimulating factor prophylaxis as supportive cancer care provides substantial value to society. Aligning utilization with clinical guidelines would increase this value considerably.
Read More
Patients with hematologic malignancy who are undergoing chemotherapy or a conditioning regimen for hematopoietic stem cell transplant (HSCT) are at high risk of infection because of the severity and duration of neutropenia. Fever with neutropenia is a common presentation that suggests an infection leading to empiric antibacterial therapy. To prevent infection and thus the neutropenic fever, antibacterial prophylaxis, especially with fluoroquinolones, emerged as a common practice based on results of 2 randomized controlled trials published in 2005 that showed reduced incidence of fever and bacteremia despite lack of a mortality benefit.
Read More
Neutropenia Etiology Influences Resulting Hematologic Consequences
March 2nd 2019Hematological consequences of severe chronic neutropenia vary based on the underlying etiology of the condition, according to a study abstract presented at the 60th American Society of Hematology Annual Meeting & Exposition.
Read More
Home Monitoring Device for Blood Cell, Neutrophil Counts Shows Positive Initial Results
February 22nd 2019Initial results of a study have found that white blood cell counts and absolute neutrophil counts, which are well-established predictors of risk of infections or febrile neutropenia, can be accurately measured with a finger stick drop of blood and point-of-care hematology results.
Read More
