Administering Nivestym at Home Is Effective and Well-Received by Patients

Neutropenia is a common complication arising in myelosuppressive chemotherapy that can be prevented and treated with filgrastim. A recent study provides insight into the feasibility of at-home administration of biosimilar filgrastim—Pfizer’s recently approved Nivestym—an option that has the potential to reduce patient burden associated with hospital administration.

The prospective, non-interventional, non-comparative, multicenter study was conducted in Germany. A total of 171 patients undergoing cytotoxic chemotherapy at 29 sites were enrolled from 2015 to 2016, and were followed for up to 6 months. In total, 123 patients completed at least 3 cycles of treatment.

In terms of the effectiveness of at-home filgrastim treatment, mean absolute neutrophil count increases of between 3.3 and 6.2×10⁹/L were observed in the first 3 cycles, and there were no cases of neutropenia observed, though 1 event of febrile neutropenia was documented. Fifteen infections were recorded in 14 patients; 12 nonserious infections occurred in 11 patients and 3 serious infections occurred in 3 patients.

When asked to rate the tolerability of filgrastim at the injection site, 63.3% replied “very good” at least once, and 62.7% said “good” at least once. In 31.4% of patients, administration was “pain-free,” while 75.7% experienced “a small prick” and 24.9% felt a “light stitch” at least once. In total, 69.2% of patients felt that the tolerability of the drug was “good” at least once. Adverse events occurred in 19.9% of patients, and 5 events in 5 patients were serious.

Furthermore, patients’ satisfaction with at-home administration, measured using a questionnaires in 169 patients, found that 56.2% were given training in handling the syringes during at least 1 treatment cycle, and 84.2% of the trained group found this education useful. Most patients performed the injections themselves (71.0%).

The majority of patients (85.2%) said that the packaging of the biosimilar filgrastim was easy to handle. Following training, 72.2% of patients rated the handling instructions as straightforward and easy to understand. Nearly all of the patients (99.4%) said that the syringes were easy to use. On a scale of 1 to 6, on which 1 indicates that a patient is very satisfied and a 6 indicates that a patient is absolutely dissatisfied, the average patient satisfaction score was 1.9 (±0.9).

Most patients received injections according to their prescriptions. In the first cycle, only 5.8% of patients did not take filgrastim as prescribed; 1 reason for non-compliance was unknown, 5 patients forgot to inject, 2 discontinued treatment on investigator advice, and 2 independently decided to discontinue treatment.

The study’s authors say that home-based biosimilar filgrastim treatment was effective, well tolerated, and well received by the patients participating in the study, and that there exists a potential for cost-savings in using home administration. Using short-acting biosimilar agents in the home setting instead of using the more expensive long-acting pegfilgrastim could reduce costs without adding to the patient’s burden by requiring repeated visits to the clinic for administration.

Reference

Otremba B, Hielscher C, Petersen V, Petrik C. Home administration of filgrastim (Nivestim) in primary prophylaxis of chemotherapy-induced febrile neutropenia. Patient Prefer Adherence. 2018;12:2179-2186. doi: 10.2147/PPA.S168029.