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Pegfilgrastim-Induced Bone Pain: A Review on Incidence, Risk Factors, and Evidence-Based Management
Donald C Moore1, Annie E Pellegrino1
11 Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA.
Objective:
To review the incidence, risk factors, and management of pegfilgrastim-induced bone pain (PIBP).
Data Sources:
PubMed was searched from 1980 to March 31, 2017, using the terms pegfilgrastim and bone pain.
Study Selection And Data Extraction:
English-language, human studies and reviews assessing the incidence, risk factors, and management of PIBP were incorporated.
Data Synthesis:
A total of 3 randomized, prospective studies and 2 retrospective studies evaluated pharmacological management of PIBP. Naproxen compared with placebo demonstrated a reduction in the degree, incidence, and duration of bone pain secondary to pegfilgrastim. Loratadine was not effective in reducing the incidence of bone pain prophylactically, but a retrospective study evaluating dual antihistamine blockade with loratadine and famotidine demonstrated a decreased incidence in bone pain when administered before pegfilgrastim.
Conclusion:
Naproxen is effective at managing PIBP. Although commonly used, antihistamines have a paucity of data supporting their use. Dose reductions of pegfilgrastim and opioids may also be potential management options; however, data supporting these treatment modalities are scarce.
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