On-Body Injector as Effective as Manual Injection of Pegfilgrastim for Preventing Febrile Neutropenia

Typically, granulocyte colony-stimulating factor is given 24 hours after chemotherapy to reduce the risk of febrile neutropenia in patients with cancer. But, for patients who are underinsured and don’t have coverage for home injections, this involves a second trip to the clinic. In 2015, the Neulasta On-Body Injector (OBI) Onpro device was introduced as a less costly method of pegfilgrastim (Neulasta) administration. The device is attached to the patient’s arm and timed to automatically deliver an injection 27 hours after application, allowing the patient to avoid another clinic visit.

While the device has been found to be safe in healthy volunteers and have pharmacokinetics similar to that of traditional pegfilgrastim, there have been limited data comparing the 2 methods. According to a study presented at the 60th American Society of Hematology Annual Meeting & Exposition, the device is as effective as manual injection of pegfilgrastim in preventing febrile neutropenia.

Between May 1, 2016, and May 30, 2017, the researchers reviewed the use of the 2 pegfilgrastim delivery systems among 120 patients at a large urban cancer center. Half of the patients returned to the clinic a day after chemotherapy for manual injection while the other half went home and used the OBI device.

All patients were receiving high-risk chemotherapy regimens, and the average age ranged from 55.6 to 56.1 years between the 2 groups.

During the period, 17 (14%) of the patients developed febrile neutropenia, with 16.7% of those receiving manual injection of pegfilgrastim developing the condition and 8.3% of those using the OBI device developing the condition.

“There was a non-significant increase in febrile neutropenia in the manual injection group but this may have been due to a significant imbalance of more myelosuppressive non-Hodgkin lymphoma regimens,” explained the researchers. While 11.7% of patients in the OBI device group had non-Hodgkin lymphoma, 38.3% of patients in the manual injection group had the disease.

Among the patients who developed febrile neutropenia, nadir absolute neutrophil count, on average, was 160 for the manual injection group compared with 432 in the OBI device group.

All patients who developed febrile neutropenia were admitted for inpatient care and treated with intravenous antibiotics, with average length of stay being 6.6 days for the manual injection group compared with 4.4 days for the OBI device group.

Among the patients using the OBI device, 3 (5%) reported that the injector fell off after attachment.

“Overall, in patients exposed to high-risk chemotherapy, OBI use resulted in a low incidence of febrile neutropenia and fewer return clinic visits, but education on handling device failure is vital to the effectiveness of the pegfilgrastim OBI in this patient population,” noted the researchers.

Reference

Jindal A, Kover J, Raduka V, O'Brien T. Incidence of neutropenic fever at a safety net hospital in cancer chemotherapy patients receiving prophylactic pegfilgrastim manual injection compared to the on-body auto-injector. Presented at: 60th American Society of Hematology Annual Meeting & Exposition; December 1, 2018; San Diego, CA. Abstract 4709.