Filgrastim to treat neutropenia and support myelosuppressive medication dosing in HIV infection

Phillippe Hermans, Willy Rozenbaum, Antoni Jou, Francesco Castelli, Jan Borleffs, Stephen Gray, Nick Ward, Andrea Gori, Anna De Bona, Carlos Ferré, Montserrat Loncà, Jean Marie Lang, Adriana Ammassari, Nathan Clumeck

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Patients with HIV infection frequently experience disease or treatment-related myelosuppression leading to neutropenia. Neutropenia often leads to dose-reduction or discontinuation of important myelosuppressive therapy. Objective: To examine the efficacy and safety of filgrastim for reversing neutropenia and determine the effect of this on use of myelosuppressive medications. Design: Open-label, non-comparative, multicentre study in 200 HIV-positive patients with neutropenia [absolute neutrophil count (ANC) <1.0 x 109/l]. Filgrastim was started at 1 μg/kg/day subcutaneously for 28 days. This initial treatment phase was followed by a maintenance phase, using 300 μg on 1-7 days/week. In both phases the dose of filgrastim was adjusted to achieve an ANC of 2-5 x 109/l. Results: Filgrastim reversed neutropena in 98% of patients (ANC ≤ 2 x 109/l), with a median time to reversal of 2 days (range 1-16) and a median dose of 1 μg/kg/day (range 0.5-10). Most patients (96%) achieved reversal of neutropenia with a filgrastim dose of ≤ 300 μg/day (≤ 1 vial/day). Normal ANCs were then maintained with a median of 1 μg/kg/day (range 0.22-10.6) during the treatment phase and 3 x 300 μg vials/week (range 1-7) during the maintenance phase. Ganciclovir, zidovudine, co-trimoxazole and pyrimethamine were the drugs most frequently considered to be causing neutropenia, and 83% of patients received one or more of these in the study. Filgrastim allowed > 80% of patients to increase or maintain dose-levels of these four medications or add them to their therapy. The number of these four medications received per patient increased by > 20% during filgrastim therapy. Filgrastim was well tolerated. CD4, CD8 and total lymphocyte counts all increased slightly, and there was no difference in HIV-1 p24 antigen levels. Conclusion: Filgrastim rapidly reverses neutropenia and maintains normal ANC in patients with HIV infection. This allows greater use of myelosuppressive medications without the potentially life-threatening complications of neutropenia.

Original languageEnglish
Pages (from-to)1627-1633
Number of pages7
JournalAIDS (London, England)
Volume10
Issue number14
Publication statusPublished - 1996

Keywords

  • AIDS
  • Filgrastim
  • Granulocyte-colony stimulating factor
  • HIV infection
  • Myelosuppuessive medication
  • Treatment of neutropenia

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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