Are Neupogen and Neulasta Truly Worthless Drugs?

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So many cancer and lymphoma patients know how this goes: After receiving their chemotherapy cycles, there is a fear of a depletion of B-lymphocytes in the body, so they are prescribed a white cell boosting drug as a precaution to prevent against febrile neutropenia. In other words, better safe than sorry.

So the patient must endure the dreaded, painful shot of a white blood cell boosting drug, generally either Neupogen (or G-CSF) or Neulasta (or peg G-CSF).

These are unpopular shots for many because they can be painful for days afterwards.

They may be worthless too.

New England Journal of Medicine

In the 21 March 2013 issue of the NEJM is an article co-authored by University of Nebraska Medical Center oncologist James Armitage MD, a world-renowned expert in lymphoma.

According to Armitage and co-author Charlie Bennett, M.D., Ph.D. - who, by the way, together author the national guidelines on G-CSF and GM-CSF - the U.S. spends about $6 billion annually on these drugs, despite the fact that they offer no medical benefits to most cancer patients receiving them.

To the point, about 10 percent of patients receiving these drugs get some clinical benefit. This 10 percent is composed of elderly patients with multiple conditions.

The other 90 percent get next to nothing from it - except a bill for as much as $3,000 per shot.

Said Bennett:

This is a great illustration of what's wrong in the American health care system. We simply cannot afford as a country to continue wasting billions of dollars on treatments that do nothing to improve the health of patients.

Added Armitage:

These drugs have made a significant impact in the practice of medicine, however in oncology, they are still evolving as reflected in this article.

Recent recommendations by the American Society of Clinical Oncology and European experts stress that only a small subset of patients should be getting the drug. And, in fact, current oncology guidelines are consistent about this: the drugs should only be used in settings where risks of low white blood cell counts causing infections are very high - again, elderly patients with many conditions.

Current practice, however, has oncologists giving these shots to all cancer patients.

The authors believe that properly addressing the enormous overuse of these drugs would lower the health care costs of the country - not to mention individual cancer patients - while contributing to the well-being of the patient.

You think?

[James Armitage, M.D.,is the Joe Shapiro Professor of Internal Medicine in the UNMC Division of Oncology/Hematology and the former president of the American Society of Clinical Oncology. Charlie Bennett, M.D., Ph.D., is the Josie M. Fletcher Professor of Pharmacy of the University of South Carolina campus of the South Carolina College of Pharmacy.]

Source: Bennett CL et al. Colony-Stimulating Factors for Febrile Neutropenia during Cancer Therapy. N Engl J Med 368:1131-1139.

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