Comparative safety of filgrastim versus sargramostim in patients receiving myelosuppressive chemotherapy

STUDY OBJECTIVE

To compare rates of adverse events with filgrastim versus sargramostim when given prophylactically to patients receiving myelosuppressive chemotherapy.

DESIGN

Retrospective review with center crossover.

SETTING

Ten United States outpatient chemotherapy centers.

PATIENTS

Four hundred ninety patients treated for lung, breast, lymphatic system, or ovarian tumors.

INTERVENTION

Prophylactic use of filgrastim or sargramostim, with dosages at investigator discretion.

MEASUREMENTS AND MAIN RESULTS

The frequency and severity of adverse events and the frequency of switching to the alternative CSF were assessed. There was no difference in infectious fever. Fever unexplained by infection was more common with sargramostim (7% vs 1%, p<0.001), as were fatigue, diarrhea, injection site reactions, other dermatologic disorders, and edema (all p<0.05). Skeletal pain was more frequent with filgrastim (p=0.06). Patients treated with sargramostim switched to the alternative agent more often (p<0.001).

CONCLUSION

Adverse events were less frequent with filgrastim than with sargramostim, suggesting that quality of life and treatment costs also may differ.

Comparison of G-CSF and GM-CSF adverse event profiles in office-based practices: preliminary study results

We investigated the adverse event profile of colony-stimulating factors (CSFs) used in office-based oncology practices in the United States. The impetus for the study was anecdotal reports from physicians and nurses working in community practice settings describing the differences in adverse drug events (ADEs) that their-patients experienced with the two CSFs currently available in the United States. The study was a retrospective review of office-based oncology practice records. The frequencies of drug-induced fever and other ADEs secondary to granulocyte (G)-CSF were compared with those of granulocyte-macrophage (GM)-CSF. Adverse drug events were those events that were documented by a clinician as being causally linked to CSF therapy and not obviously due to other causes. This preliminary report of the data indicated that there were some significant differences in the ADEs attributable to either G-CSF or GM-CSF. The appropriate use of CSFs in clinical practice also is discussed.