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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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, but what's the difference, and how does your doctor choose between them?

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).

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, 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.

Side effects are almost the same. Bone pain is the most common side effect of both drugs, experienced by 31 percent to 26 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).

Cost Per Injection 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. 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 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 clears 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.

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), but 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.

Bottom Line on Neulasta or Neupogen

both Neulasta and Neupogen can signifcantly reduce your risk of infection during chemotherapy, and these drugs now allow people to receive a higher dose (and more effective) of these drugs than was previously possible. There are a few differences, including a higher rate of severe neutropenia with Neupogen (at least for people with breast cancer) and a greater incidence of bone pain on Neulasta.

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