Primary prophylaxis with pegfilgrastim in patients with newly-diagnosed diffuse large B-cell lymphoma: propensity score and instrumental variable analyses

Abstract

The clinical impact of pegfilgrastim in day-to-day practice remains unclear. This study evaluated the effectiveness of pegfilgrastim compared with daily filgrastim in patients with DLBCL who received the first-cycle of R-CHOP treatment by using a Japanese national inpatient database. Patient characteristics were adjusted by using propensity-score matching and stabilized inverse probability of treatment weighting (IPTW). In 1295 propensity-score-matched pairs, the incidence of febrile neutropenia was significantly lower in the pegfilgrastim group (risk difference 6.1%, 95% CI 4.1%–8.1%) than in the filgrastim group. In the pegfilgrastim group, the length of hospital stay and the total costs were also significantly reduced (percent reduction 34% [95% CI: 31%–37%], percent reduction 12% [95% CI: 9%–15%], respectively). The stabilized IPTW showed comparable results. In day-to-day practice, the simple mode of pegfilgrastim administration may be advantageous.

Keywords:

• Pegfilgrastim
• filgrastim
• Febrile neutropenia
• malignant lymphoma
• propensity-matched analysis

Authors’ contribution

KM, TJ, and MM designed the research. KT, KN, HY, and MK advised the research design and analyses. HY, HM and KF collected the patient’s data, KM and TJ analyzed the data. KM wrote the paper. All authors revised the manuscript, and approved the final manuscript.

Disclosure statement

Taisuke Jo received the consigned research funding from Tsumura, and he belongs to the laboratory of joint program with Tsumura. Masashi Miyauchi received the research funding from Kyowa Kirin. Kazuhiro Toyama received the lecture free from Kyowa Kirin, Eisai, Bristol-Myers Squibb, Celgene, Daiichi Sankyo, Nippon Shinyaku, Chugai Pharmaceutical, Ono Pharmaceutical, Otsuka Pharmaceutical, and Takeda Pharmaceutical. Kiyohide Fushimi received the scholarship donation from Chugai Pharmaceutical. Mineo Kurokawa received the research funding from Pfizer, Otsuka Pharmaceutical, Chugai Pharmaceutical, Astellas, Kyowa Kirin, Takeda Pharmaceutical, MSD, Teijin, Eisai, Sumitomo Dainippon Pharma, Novartis, Nippon Shinyaku Bristol-Myers Squibb, Daiichi Sankyo, and Ono Pharmaceutical. Mineo Kurokawa received the advisory fee from Shionogi, Kyowa Kirin, Celgene, Bioverativ Japan, Chugai Pharmaceutical, and MSD. Mineo Kurokawa received the lecture fee from MSD, Astellas, Eisai, Otsuka Pharmaceutical, Ono Pharmaceutical, Yakult Honsha, Shire Plc, Celgene, Daiichi Sankyo, Sumitomo Dainippon Pharma, Takeda Pharmaceutical, Chugai Pharmaceutical, Boehringer Ingelheim, Bristol-Myers Squibb, Jansen Pharmaceutical, Kyowa Kirin, and Nippon Shinyaku.

None of these is related to the current study.

Additional information

Funding

This work was supported by grants from the Ministry of Health, Labor and Welfare, Japan [19AA2007 and H30-Policy-Designated-004] and the Ministry of Education, Culture, Sports, Science and Technology, Japan [17H04141]. The funding bodies had no role in the design of the study; collection, analysis, or interpretation of the data; or writing of the manuscript.