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Does Neulasta cause bone pain?

How long does bone pain last from Neulasta (pegfilgrastim)?

Medically reviewed by Melisa Puckey, BPharm. Last updated on Jul 31, 2020.

Official Answer

by Drugs.com

Does Neulasta cause bone pain?

Yes, Neulasta can cause the side effect of bone pain.

Bone pain is considered to be a very common side effect of Neulasta

  • bone pain (up to 31%)
  • skeletal pain (up to 27%)
  • medullary bone pain (up to 26%)

Why does Neulasta cause bone pain?

Neulasta (pegfilgrastim) can be used to increase the neutrophil levels by stimulating production, maturation, activation and release of neutrophils from the bone marrow.

Because Neulasta has its clinical effect within the bone marrow,  it is these changes  that also causes the side effects of bone pain, skeletal pain and medullary bone pain.

Neulasta is thought to cause bone pain by affecting:

  • bone marrow expansion
  • bone metabolism
  • peripheral nerve being sensitized
  • histamine which can cause inflammation and local swelling

Patients undergoing chemotherapy often have a decrease in neutrophils (a type of white blood cell that fights infection) which makes them susceptible to infections.  These patients can take Neulasta to help increase neutrophil levels, to help reduce infection risk.

How long does bone pain last from Neulasta?

Reliable information on how long bone pain from Neulasta lasts is not easily available.
In the NOLAN study of bone pain caused by Neulasta

  • pain usually starts within two days of administration
  • the most painful day was day 3
  • then pain improved slightly on day 4 and day 5.

This study only measured pain up to day 5, when there was still a high level of pain and pain had not yet returned to pre-treatment levels.

In another study patients' pain levels were measured before Neulasta treatment, then 8 days after treatment and the results showed

  • 49%  (111 of 227 patients) still had pain 8 days after treatment that was at a higher level than before treatment. 

These studies indicate that bone pain from Neulasta lasts at least 8 days for almost half of the patients, and bone pain is likely to last a lot longer for a number of patients.

Bottom line:

  • Bone pain is a very common side effect of Neulasta
  • Neulasta has a positive effect on bone causing increases in neutrophil levels,  but also Neulasta has a negative effect which causes bone pain due to bone marrow expansion, bone metabolism, peripheral nerve being sensitized and affecting histamine which can cause inflammation and local swelling.
  • Bone pain caused by Neulasta lasts at least 8 days for 49% of the patients, and most likely longer for a large number of patients.
References
  • Neulasta side effect information: https://www.drugs.com/sfx/neulasta-side-effects.html
  • Neulasta medicine information: https://www.drugs.com/pro/neulasta.html
  • NOLAN: a randomized, phase 2 study to estimate the effect of prophylactic naproxen or loratadine vs no prophylactic treatment on bone pain in patients with early-stage breast cancer receiving chemotherapy and pegfilgrastim: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5847062/
  • Randomized phase II study of loratadine for the prevention of bone pain caused by pegfilgrastim: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266505/

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