what is the difference between neulasta and neupogen

[cjsam]

Doc was hard pressed to give me neupogen, but finally did.  It may not be enough, cause counts are dropping again anc went from 5000 to 830.  Anyway it seems the counts have been ok the first couple days then they dive, so I'm thinking (I know I'm not the doc) that either more than one neupogen shot a week or taking neulasta instead would be beneficial.  From what I  understand neulasta is a pegalyted version of neupogen and stays in your system longer, is this true?

Also if you are on neupogen, out of curiosity, how many shots do you take a week.  I noticed many seem to take 2 or 3 shots/ wk, guess it depends on the person though.

thanks

[cjsam]

Thanks guys.  My ANC had been going back and forth but started to go lower and lower.  I've haven't been dose reduced ever in the traditional sense, but have had my shot delayed 3,4,5 days, twice I had to miss a week cause of low ANC.  MY mom (whos a nurse) helped advocate for me, as did I and the Doc finally agreed to neup.  At that point my ANC was around 620 or so (he usually makes me delay the shot if it goes below 750).  I took the neup AC shot up to 5000, ,skipped a week of neup, ANC shot back down, and then took the neup the following week (this week).  My most recent blood test was wednesday and the ANC was at 880.  I was told to take the neup wednesday, and take my shot friday (today).  My doc has me taking the neup two days before my shot (i take neup wed, shot friday), however because my counts dropped again I have a feeling one neup shot may not be enough.

BTW I don't know if anyone has tried it but i take claritan (a full 24hr dose) the day of the neup shot and each day for two days after.  And this time before I go to bed i take 8hr tylenol.  Seems to be helping with bone pain.  I found out about it from an oncology nurse.

[frijole]

OK - have to get this straight in my mind first.  On my bloodwork reports, ANC is reported in K/uL.  Therefore 5000 would be reported as 5.0 -- a very nice pretreatment  neutrophil count, by the way (mine was only 2.8 -- 2800).   830 would be reported as .83.  This .83 is still not a bad number during treatment.  You can look back and find lots of discussion (and I use that term lightly) on when to start neupogen.  The problem is that most doctors rxing neupogen are associated with the oncology departments in hospitals.  With cancer you cannot let that ANC drop below 1.0 (1000) -- can't remember exact numbers -- because of risk of infection.  However, under hep C treatment you can actually sustain a much lower ANC without risk of infection. I believe 500 is a borderline ANC for starting neupogen.   I will look for some studies to post.

You will never never get your ANC up to 5000 on treatment. Even with neup my ANC stayed about 800, sometimes 1000. Remember, that you want your neutrophils built up to fight infection but if you are not prone to infection (and summer is better than winter) than, 830 may be just fine for you.  It certainly does not sound like you need more than one a week right now.  And, you are right, it only lasts a few days

I fought against taking neup by showing studies to the hemotologist.  However, when ANC hit .4 (400) I began (week 15).  At first only once every 2 weeks and later once a week and near the end of my 56 week treatment, 2 times a week and after treatment for a month or so until the counts came back up.  And, by the way, the hemotologist said after chemotherapy (which hep C treatment is) sometimes ANC never goes back to pretreatment numbers.

The other thing not mentioned by other members is that neup counteracts interferon.  My hemo told me to take it 24-48 hours before or after interferon but no closer.  Definitely do not add neupogen to "shot night."

Hope this helps
frijole

[newleaf09]

I used the Neulasta.  Sent my neuts up to 13,000 the first time and lasted a month.  Up to 12,000 the second time, less with the third shot (6700).  I was able to go longer between the shots as TX went on because my IFN was reduced so much and so my bone marrow was a little less suppressed.  In total, I had to use it 3 times over the 28 week course of TX.  I think it cost my insurance company about $3500 per shot with a $50 copay for me.  I had no bone pain or any other ill effects from it that I know of.

[JennyPenny2009]

Like others have said the neulasta stays in the body for a longer time. However, it is actually the white count that turns the neupogen or neulasta off. Once the count starts to climb and reaches a certain level, the neulasta/neupogen no longer works. When the level comes down a new injection of neupogen starts the progress again. If you're on neulasta it stays in your body about 3 weeks so if the count drops after a week or so, it will start working again.

[Annie441]

I took Neupogen for about 50 of the 72 wks I TX. When I did the full dose my WBC skyrocketed and without it the WBC went very very low like 200 if I remember correctly. So I split one dose into 3 shots. For awhile I had blood drawn twice a week to make sure we found the right dosage. Doing it that way put an end to my couple of good days I had in the week, cause like Trinity and FlGuy said it's nasty stuff, but you do what you have to do to get SVR.

Ann

[FlGuy]

I used both.  'lasta is longer working, but I think the side effects (mostly bone pain) were worse than Neupogen which, for me, was side effect free. I also took a look at the charges to my insurance co.  Neulasta was $7000 (yes, thousand) per shot.  Neup was $400.  Even with the longer lasting aspect, Neulasta was more expensive.  I prefer the shorter and more frequent Neupogen for both the cost (although I did not even have a copay) and the lack of sides, even considering the increased inconvienience.  Yeah, I thought Neulasta was pretty nasty.

[Trinity4]

Yes, Neulasta is the pegylated version of Neupogen.  A polyethylene glycol molecule or (“PEG”) is added to enlarge the Filgrastim molecule (Neupogen), thereby extending its half-life and causing it to be removed more slowly from the body.

I don't know what the dosage requirements are for Neulasta but it is not taken as often as Neupogen.  My experience with Neupogen was 1 injection per week initally, then 2 and several times I was reduced to half dosage or skipped several weeks because my WBC was high.  It's a balancing act and usually those on Neupogen require more blood draws than those who are not taking it.

I thought it was some nasty stuff.  Caused bone pain and fevers but it kept me from being dose reduced or taken off treatment.

Trinity