Advantages and Disadvantages of Two Commonly Used Treatments
You may be asked to choose between the drugs Neulasta and Neupogen when undergoing chemotherapy. Chemotherapy can cause your white blood cell counts to drop, which puts you at risk of infection. Neutropenia (a low level of one of the types of white blood cells) is treated with Neulasta or Neupogen which not only lower the risk of infection, but can offer the opportunity to use higher doses of chemotherapy (and in doing so, may reduce the risk of recurrence of some cancers). What are the important differences between Neulasta and Neupogen that can help you and your doctor choose the medication that’s best for you?
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). In the human body, granulocyte-colony stimulating factor is responsible for stimulating the production and release of neutrophils from the bone marrow. In essence, using these medications can be thought of as adding to the body’s natural production when a rapid increase in neutrophils is needed.
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 a chemotherapy infusion, and no sooner than 14 days before your next 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 and Side Effects
In clinical trials, both drugs compared favorably with regard to:
- Effectiveness in boosting neutrophil production
- Tolerability by patients
- Safety of use
While both medications are very effective, a2015 study found that severe neutropenia (an extremely low neutrophil count) was significantly lower in people who were treated with Neulasta during breast cancer chemotherapy. Those receiving Neulasta were also less likely to require a reduction in their chemotherapy dose or a delay between infusions. Both a reduction or delay in chemotherapy have the potential to reduce the effectiveness of treatments.Side effects of Neulasta and Neupogen are roughly the same. Bone pain is the most common side effect of both drugs, experienced by 26 percent to 31 percent of people on Neulasta and 24 percent of people on Neupogen. Those who are very bothered by bone pain may sometimes choose Neupogen over Neulasta for this reason (though it is more inconvenient to use). Many oncologists prescribe pain medications that can be used as needed to help people cope with the bone pain.
Neulasta is more expensive than Neupogen, but the number of doses of Neupogen required can reduce the differences between the costs of these drugs. It’s also important to keep in mind the cost of hospitalization for severe neutropenia (and subsequent risk of infections) that is more common among those receiving Neupogen.
- One 6 mg Neulasta injection will cost between $5,000 to $7000, depending on the supplier.
- One 300 microgram Neupogen injection will cost between $300 to $350.
- One 6 mg injection of Neulasta costs about the same as 10.4 300 microgram injections of Neupogen.
- Amgen provides a FIRST STEP Program for reducing co-pay costs of these drugs for those with private commercial health insurance.
Will 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 may be asked to sign a form that obliges you to cover the cost of these drugs if your insurance won’t pay for it.
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 neutropenia, 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 Chemotherapy 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 because it is cleared from 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. When considering this option, however, make sure to talk to your oncologist about the potential for allergic reactions, and what you need to know if you should have problems.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.
It’s important to keep in mind that, even if you are receiving Neulasta or Neuopogen, you may still be at an increased risk of infection. Chemotherapy can drastically reduce the number of white blood cells in your blood (the goal of using these drugs), and while Neulasta and Neupogen can increase your counts, they may not bring them to normal levels, and the white blood cells that are present may not work as well as “normal” white blood cells. Learning how to reduce your risk of infection during chemotherapy is important as many people are unaware of some of the simple things they can do to lower their risk.
A Word From Verywell
Both Neulasta and Neupogen can significantly reduce your risk of developing an infection during chemotherapy, and these drugs now allow people to receive a higher(and more effective) doses of chemotherapy drugs than was previously possible. There are a few differences, with Neulasta being more effective and more convenient, though the incidence of bone pain is higher than Neupogen. The increased cost and bone pain with Neulasta may, however, be less of an issue in the future, as a 2018 study looking at Neulasta in women with breast cancer found that using 3 mg (instead of 6 mg) reduced both the cost of treatment and amount of bone pain, but with the same effectiveness as the higher dose.