Table of ContentsView AllTable of ContentsHow They WorkNumber of InjectionsEffectivenessSide EffectsCostFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
How They Work
Number of Injections
Effectiveness
Side Effects
Cost
Frequently Asked Questions
Neulasta (pegfilgrastim) and Neupogen (filgrastim) are both injections given afterchemotherapyto help stimulate white blood cell (WBC) production and reduce the chance ofneutropenia.
Chemotherapy destroys both healthy and unhealthy fast-growing cells (like cancer). WBCs are healthy cells that help prevent infection.Neutrophilsare 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 calledneutropenia. Fortunately, some medications help prevent neutropenia.
This article will explain the differences between Neulasta and Neupogen.
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 apolyethylene 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 hoursaftereach 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.
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.
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.
Other potential side effects include:
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 infectioneven ifyou 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 toreduce your risk of infectionduring cancer treatment is essential to your health and well-being on this journey.
Cost of Neulasta and Neupogen
According toGoodRx.com, here are the current costs of both medications:
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 theirAmgen ASSIST 360 program.
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 tobe your own advocateand 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
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 QuestionsAlthough 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.Depending on your insurance coverage and availability, Neupogen may be given at home.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.
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.
Depending on your insurance coverage and availability, Neupogen may be given at home.
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 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Food and Drug Administration.Neulasta label.Food and Drug Administration.Neupogen label.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 review.Support Care Cancer. 2015;23(2):525-545. doi:10.1007/s00520-014-2457-zKirshner 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.2011.37.8364Breastcancer.org.Neulasta.Additional ReadingHauber BA, Mange B, Price M, et al.Administration options for pegfilgrastim prophylaxis: patient and physician preferences from a cross-sectional survey.Supportive Care in Cancer. 2018;26(1):251-260.
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Food and Drug Administration.Neulasta label.Food and Drug Administration.Neupogen label.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 review.Support Care Cancer. 2015;23(2):525-545. doi:10.1007/s00520-014-2457-zKirshner 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.2011.37.8364Breastcancer.org.Neulasta.Additional ReadingHauber BA, Mange B, Price M, et al.Administration options for pegfilgrastim prophylaxis: patient and physician preferences from a cross-sectional survey.Supportive Care in Cancer. 2018;26(1):251-260.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Food and Drug Administration.Neulasta label.Food and Drug Administration.Neupogen label.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 review.Support Care Cancer. 2015;23(2):525-545. doi:10.1007/s00520-014-2457-zKirshner 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.2011.37.8364Breastcancer.org.Neulasta.
Food and Drug Administration.Neulasta label.
Food and Drug Administration.Neupogen label.
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 review.Support Care Cancer. 2015;23(2):525-545. doi:10.1007/s00520-014-2457-z
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
Breastcancer.org.Neulasta.
Hauber BA, Mange B, Price M, et al.Administration options for pegfilgrastim prophylaxis: patient and physician preferences from a cross-sectional survey.Supportive Care in Cancer. 2018;26(1):251-260.
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