Neulasta vs. Neupogen for Treatment of Neutropenia During Chemo

Advantages and Disadvantages of Two Commonly Used Treatments

Neulasta (pegfilgrastim) and Neupogen (filgrastim) are both injections given after chemotherapy to help stimulate white blood cell (WBC) production and reduce the chance of neutropenia.

Chemotherapy destroys both healthy and unhealthy fast-growing cells (like cancer). WBCs are healthy cells that help prevent infection. Neutrophils are an important type of WBC.

Chemotherapy can cause the neutrophil count to drop, resulting in serious infections and delays in treatment. This low neutrophil count is called neutropenia. Fortunately, some medications help prevent neutropenia.

This article will explain the differences between Neulasta and Neupogen.

Patients undergoing medical treatment at an outpatient clinic
Caiaimage / Martin Barraud / Getty Images

How Neulasta and Neupogen Work

Neulasta and Neupogen are both made of a natural protein known as granulocyte-colony stimulating factor (or "G-CSF"). In the human body, granulocyte-colony stimulating factor is responsible for increasing the production and release of neutrophils from the bone marrow.

Neulasta (generic name pegfilgrastim) has a polyethylene glycol, "PEG," unit added to it. This larger "PEG" molecule stays in your system longer than Neupogen (filgrastim). Since Neulasta stays in the body longer, fewer doses are needed for it to be effective.

It is important to note that not all chemotherapy requires the use of Neulasta or Neupogen. Your oncologist will discuss your need for a G-CSF.

The Number of Injections Needed

Neulasta is given at least 24 hours after each chemotherapy cycle. Chemotherapy cycles depend on the treatment regimen prescribed to you.

Some patients will go home with a device that automatically delivers Neulasta on the correct day and time. This device is called an on-body injector (OBI). The infusion nurse will program the OBI and attach it to your arm before you leave the clinic.

If this device is unavailable, you will return to the clinic 24 hours after chemotherapy to receive the injection. Neulasta should not be administered more often than every 14 days.

Neupogen is also started 24 hours after chemotherapy. In contrast to Neulasta, however, it is given daily for several days in a row. Factors such as your neutrophil count, treatment type, and medical condition help determine how many daily Neupogen injections are required. Although this medication is not available as an OBI, you may be able to administer it yourself at home.

Effectiveness

Although both Neulasta and Neupogen have been proven effective in decreasing neutropenia, clinical trials show that Neulasta may have the upper hand.

One systematic review study looked at multiple previous studies and found that long-acting G-CSFs, like Neulasta, had better efficacy and effectiveness than the short-acting equivalents like Neupogen. Additionally, Neulasta is more convenient to administer as a one-time, single dose.

Side Effects

Bone pain is likely the most significant side effect of G-CSFs. One study found that around 30% of patients receiving Neulasta experienced bone pain compared to 24% of those on Neupogen. Bone pain occurs due to swelling in the bone marrow as WBCs are being stimulated to reproduce.

Nonsteroidal anti-inflammatory drugs (NSAIDs) have shown to be more effective in treating bone pain than narcotics. There is also growing evidence that Claritin (loratadine) could be a useful option in alleviating bone pain.

Patients with certain blood cancers should avoid using G-CSFs as these medications may worsen the condition by triggering the growth of cancer cells.

Other potential side effects include:

  • Ruptured spleen
  • A serious lung condition called ARDS
  • Sickle cell crisis
  • Kidney injury
  • Increased WBCs
  • Decreased platelet count
  • Capillary Leak Syndrome
  • Secondary cancer
  • Inflammation of the aorta

Allergic reactions are a possibility with both Neulasta and Neupogen. Some healthcare providers require that you receive your first dose in the clinic and be observed for 30 minutes after the injection.

Preventing Infections

It's important to keep in mind that you are at increased risk for infection even if you are receiving Neulasta or Neupogen. If you develop a fever (100.4 F or higher) at any time, you must contact your oncology team immediately. Neutropenic fever is considered a medical emergency and needs to be treated as quickly as possible.

Learning to reduce your risk of infection during cancer treatment is essential to your health and well-being on this journey.

Cost of Neulasta and Neupogen

Neulasta is, by far, more costly than Neupogen. However, the required doses of Neupogen can quickly add up. Although these prices are high, a single hospitalization for severe neutropenic fever and infection is unquestionably more expensive.

According to GoodRx.com, here are the current costs of both medications:

  • One 6-milligram Neulasta injection will cost between $6,000 and $7,000, depending on the supplier.
  • One 300-microgram Neupogen injection will cost between $300 and $350, depending on the supplier.

Will Insurance Cover the Cost?

Although most insurance companies, including government programs (like Medicare or Medicaid), cover the cost of Neulasta and Neupogen, Amgen (the makers of both medications) offers several payment options through their Amgen ASSIST 360 program.

  • Patients with commercial insurance who need reduced co-pay costs may be eligible for the Amgen First Step program.
  • Those with government insurance can be referred to an independent nonprofit patient assistance program that helps with affordability and co-pay costs.
  • For uninsured patients, The Amgen Safety Net Foundation is a nonprofit patient assistance program that can assist with accessing Amgen medicines at no cost.

In addition, many oncology clinics have social workers, financial counselors, and pharmacists who can help patients get the medications they need for free or at low cost. It's important to be your own advocate and ask questions until you feel fully informed.

Ask your healthcare provider to help advocate on your behalf if your insurance company doesn't agree to cover any drug that you need.

Save on Cost

Neupogen can be administered at home for less money, depending on your insurance coverage. The injections are shipped directly to your residence for convenience.

Your oncology nurse or pharmacist will teach you or your caregiver how to administer the injections correctly. You will also be provided with a small sharps container to place the used syringes in. Bring the container to your next oncology visit, and they can dispose of it properly.

Cancer treatment is expensive, which leads to increased stress and anxiety. After your diagnosis, meeting with your healthcare organization's financial counselor can get you the support you need sooner. In addition, being creative and thinking outside the box can help save time and money in the long run.

Summary

Both Neulasta and Neupogen can significantly reduce your risk of developing an infection during chemotherapy. They work by increasing your levels of a type of immune cell called neutrophils. Call your oncology team immediately if you have a fever or other signs of infection, like shaking chills, during cancer treatment.

Neupogen is short-acting, while Neulasta stays in the system longer. There is some evidence that Neulasta is more effective.

Bone pain is a common side effect of both drugs. Talk to your oncology nurse about how to reduce bone pain before you start a G-CSF. Taking Claritin before and several days after the injection may alleviate bone pain.

Lastly, ask to speak with your oncology clinic's financial counselor as soon as possible. They can review your health insurance benefits and help identify programs that may reduce the costs of medications like Neulasta and Neupogen.

Frequently Asked Questions

  • Which is better, Neulasta or Neupogen?

    Although some studies show that Neulasta may be more effective, factors such as cost, convenience, bone pain, neutrophil count, treatment regimen, and your medical condition all play a role in determining which option is best.

  • Can Neulasta or Neupogen be given at home?

    Depending on your insurance coverage and availability, Neupogen may be given at home.

  • How long does bone pain last after Neulasta and Neupogen?

    Bone pain usually occurs between 12 and 18 hours after the injection and can last between one and four days. Some studies show taking daily Claritin during this time helps reduce bone pain.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. Neulasta label.

  2. Food and Drug Administration. Neupogen label.

  3. Pfeil AM, Allcott K, Pettengell R, von Minckwitz G, Schwenkglenks M, Szabo Z. Efficacy, effectiveness and safety of long-acting granulocyte colony-stimulating factors for prophylaxis of chemotherapy-induced neutropenia in patients with cancer: a systematic reviewSupport Care Cancer. 2015;23(2):525-545. doi:10.1007/s00520-014-2457-z

  4. Kirshner JJ, Heckler CE, Janelsins MC, et al. Prevention of pegfilgrastim-induced bone pain: a phase iii double-blind placebo-controlled randomized clinical trial of the university of rochester cancer center clinical community oncology program research base. JCO. 2012;30(16):1974-1979. doi:10.1200/JCO.2011.37.8364

  5. Breastcancer.org. Neulasta.

Additional Reading

By Serenity Mirabito RN, OCN
Serenity Mirabito, MSN, RN, OCN, advocates for well-being, even in the midst of illness. She believes in arming her readers with the most current and trustworthy information leading to fully informed decision making.

Originally written by
Pam Stephan
Pam Stephan is a breast cancer survivor.
Learn about our editorial process