Impact of Filgrastim Versus Pegfilgrastim on Hospital Stay and Mortality Among Chemotherapy-Induced Febrile Neutropenia Patients

Abstract

Background: Febrile neutropenia (FN) is a life-threatening complication of chemotherapy that often necessitates hospitalization and may increase mortality. Objective: To compare the impact of filgrastim versus pegfilgrastim on hospital stay duration and mortality among patients with chemotherapy-induced febrile neutropenia. Methods: This prospective cohort study enrolled 199 adult patients (n = 199) with chemotherapy-induced FN at Shaukat Khanum Memorial Cancer Hospital, Peshawar, from September 2023 to May 2024. Inclusion criteria were adults diagnosed with FN requiring G-CSF therapy; those with G-CSF contraindications, pregnancy, or unrelated active infections were excluded. Patients received either filgrastim (300 mcg/day for five days) or pegfilgrastim (6 mg single dose). Clinical characteristics, neutrophil counts, and outcomes were recorded. Ethical approval was granted by the hospital IRB in accordance with the Declaration of Helsinki. Data were analyzed using SPSS v25; chi-square and Mann-Whitney U tests were applied to assess statistical significance. Results: Pegfilgrastim significantly reduced hospital stay (0 vs. 7 days; p < 0.0001) and was associated with fewer cases of severe neutropenia (0 vs. 7; p < 0.0001). All three reported deaths occurred in the filgrastim group, though not statistically significant (p = 0.118). Clinically, pegfilgrastim showed superior hematological recovery and fewer hospitalizations. Conclusion: Pegfilgrastim demonstrated greater clinical efficacy than filgrastim by reducing hospital stay and neutropenia severity without increasing mortality, making it a more effective FN management strategy in low-resource oncology settings.