Granulocyte growth factor use in elderly patients with non-Hodgkin’s lymphoma in the United States: adherence to guidelines and comparative effectiveness

Abstract

Purpose The efficacy of prophylactic granulocyte colonystimulating factors (G-CSFs) among elderly patients with non-Hodgkin's lymphoma (NHL) receiving CHOP-based chemotherapy has been demonstrated in clinical trials, and G-CSFs are recommended in guidelines. We studied guideline adherence and the effectiveness of G-CSFs in the general population. Methods We used inpatient and outpatient claims from nationally representative databases linked to cancer information from tumor registries. Patients (N = 5884) diagnosed with NHL between 2001 and 2007 who were older than 65 years and who received CHOP-based chemotherapy were included. Adherence to guidelines was measured as the use of GCSFs within 7 days of the first dose of chemotherapy. The measures of effectiveness were fever, infection, and death during cycle 1 of chemotherapy and time to cycle 2. Multiple-variable models of these outcomes were developed using logistic regression, controlling for demographic, clinical, and provider factors. Inpatient encounters for infection were similarly prevalent among patients who did or did not receive early G-CSFs (5 vs 4 %; p = 0.2). There was no association between G-CSF use and death during cycle 1. Conclusions Adherence to guidelines increased after publication of clinical trials and exceeded 70 % after publication of guidelines. G-CSFs were effective in preventing outpatient encounters for fever or infection, but not inpatient encounters or deaths during cycle 1.

Trends in use of primary prophylactic colony stimulating factors and neutropenia-related hospitalization in commercially insured patients receiving myelosuppressive chemotherapy in the United States: 2005–2017

“…It is difficult to relate results from this study with published literature because prior studies have focused on specific regimens, 17 regimens with high risk for FN, 18 any chemotherapy, 24 or elderly Medicare enrollees. 15 In their study using four health insurance databases from 2002 to 2005 (Medicare, Medicaid, and 2 commercial), Ramsey 15 The increase in use of CSF observed in this study aligns with findings from previous publications.…”

“…15,16 There is no recent data regarding changes in chemotherapy regimens by FN risk category, changes in primary prophylactic-CSF use, and incidence of NRH in commercially insured cancer patients. Available studies are limited to single cancer types with older data 17 or selected regimens. 18…”

Supportive Care in Older Adults with Cancer: Across the Continuum

“…A recent analysis of 5884 patients over age 65 using SEER data found that clinicians’ adherence to guidelines recommending primary G-CSF prophylaxis in elderly patients with NHL receiving anthracycline-based chemotherapy now approaches 70 % in the USA [61•]. Primary prophylaxis reduced the risk of outpatient encounters for fever or infection but did not have an impact on inpatient encounters or deaths during cycle 1 of chemotherapy.…”

Patient Characteristics and Utilization Patterns of Short-Acting Recombinant Granulocyte Colony-Stimulating Factor (G-CSF) Biosimilars Compared to Their Reference Product

“…Short-acting recombinant granulocyte colony stimulating factors (G-CSFs; filgrastim (Neupogen ® ), tbo-filgrastim (Granix ® )) are used as both prophylaxis and treatment of severe or febrile neutropenia caused by myelosuppressive chemotherapy [1][2][3][4]. In 2015, the US Food and Drug Administration (FDA) approved the first filgrastim biosimilar, filgrastim-sndz (Zarxio ® ), for prophylaxis and treatment of chemotherapy-induced neutropenia, with a second biosimilar, filgrastim-aafi (Nivestym ® ) being approved in 2018 [5].…”