Neulasta vs. Neupogen for Treatment of Neutropenia During Chemo

Advantages and Disadvantages of Two Commonly Used Treatments

chemotherapy infusion clinic. is Neulasta or Neuopogen better?
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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?

Differences Between Neulasta and Neupogen

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.

Injections per Chemotherapy Cycle

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.

If you are weighing which drug to used based on the frequency of injections, talk to your oncologist. There are different chemotherapy regimens used for different cancers, and sometimes even for the same type and stage of cancer. She will probably be able to give you a ballpark figure of what most of her patients need during a similar regimen to help you access the impact it will have on your life.

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, a 2015 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.

Allergic reactions are a possibility with both Neulasta and Neupogen. Some physicians require that you receive the injections at a doctors office (either at your cancer center or with your primary care physician) so that urgent medical care is present if you should have a reaction.

Cost Per Injection/Dose of Neulasta and Neupogen

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.

If you don't know whether your insurance covers Neupogen or Neulasta, phone the company before you begin chemotherapy to find out their coverage policy. They may help with the cost of Neupogen, but not Neulasta. You can still receive treatment, but you may have to stick with Neupogen (more injections) if your insurance won't cover Neulasta, or self pay for the difference.

If your oncologist feels strongly that one medication may work better than another that is not covered, she may be willing to work with your insurance company to arrange coverage. It's always worth asking. For example, if you will be receiving a chemotherapy regimen that is strongly associated with neutropenic infections, your doctor could argue that the reduced risk of hospitalization associated with Neulasta in the setting may justify the increased cost of the injections. With some insurance companies this is fairly easy, as long as you and your doctor do the leg work. With others, not so much.

Even if your insurance company will not cover the cost of the drug you prefer, and if you can't or do not wish to pay the cost (which can be steep) there may be other options. Many drug companies have drug discount programs through which they will reduce your out-of-pocket cost. You can also check around with different pharmacies. In some cases, there is tremendous variation in the cost of a drug between different pharmacies, or even the same pharmacy in different locations.

Finally, you might ask if you could be a candidate for a lower dose of Neuopogen. 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.

It's important to be your own advocate in your cancer care. Ask questions, and ask again if needed. Sometimes a patient advocate can help you resolve difficulties if they should arise.

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. The decision to use these medications at home may partly depend on your location and how far you are from timely medical care should you have a reaction.

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.

Preventing Infections

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.

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