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The following information comes from DailyMed, an FDA label information provider.

Adverse Reactions

The following clinically significant adverse reactions are discussed in greater detail in other sections of the labeling:

  • Splenic Rupture [see Warnings and Precautions (5.1)]
  • Acute Respiratory Distress Syndrome [see Warnings and Precautions (5.2)]
  • Serious Allergic Reactions [see Warnings and Precautions (5.3)]
  • Allergies to Acrylics [see Warnings and Precautions (5.4)]
  • Use in Patients with Sickle Cell Disorders [see Warnings and Precautions (5.5)]
  • Glomerulonephritis [see Warnings and Precautions (5.6)]
  • Leukocytosis [see Warnings and Precautions (5.7)]
  • Capillary Leak Syndrome [see Warnings and Precautions (5.8)]
  • Potential for Tumor Growth Stimulatory Effects on Malignant Cells [see Warnings and Precautions (5.9)]
  • Aortitis [see Warnings and Precautions (5.11)]

6.1        Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

Neulasta clinical trials safety data are based upon 932 patients receiving Neulasta in seven randomized clinical trials. The population was 21 to 88 years of age and 92% female. The ethnicity was 75% Caucasian, 18% Hispanic, 5% Black, and 1% Asian. Patients with breast (n = 823), lung and thoracic tumors (n = 53) and lymphoma (n = 56) received Neulasta after nonmyeloablative cytotoxic chemotherapy. Most patients received a single 100 mcg/kg (n = 259) or a single 6 mg (n = 546) dose per chemotherapy cycle over 4 cycles.

The following adverse reaction data in Table 2 are from a randomized, double-blind, placebo-controlled study in patients with metastatic or non-metastatic breast cancer receiving docetaxel 100 mg/m2 every 21 days (Study 3). A total of 928 patients were randomized to receive either 6 mg Neulasta (n = 467) or placebo (n = 461). The patients were 21 to 88 years of age and 99% female. The ethnicity was 66% Caucasian, 31% Hispanic, 2% Black, and < 1% Asian, Native American, or other.

The most common adverse reactions occurring in ≥ 5% of patients and with a between-group difference of ≥ 5% higher in the pegfilgrastim arm in placebo-controlled clinical trials are bone pain and pain in extremity.

Table 2. Adverse Reactions with ≥ 5% Higher Incidence in Neulasta Patients Compared to Placebo in Study 3
  Body System
          Adverse Reaction
(N = 461)
Neulasta 6 mg SC on Day 2
(N = 467)
  Musculoskeletal and connective tissue disorders
          Bone pain26%31%
          Pain in extremity4%9%


In clinical studies, leukocytosis (WBC counts > 100 x 109/L) was observed in less than 1% of 932 patients with non-myeloid malignancies receiving Neulasta. No complications attributable to leukocytosis were reported in clinical studies.

6.2       Immunogenicity

As with all therapeutic proteins, there is a potential for immunogenicity. The detection of antibody formation is highly dependent on the sensitivity and specificity of the assay. Additionally, the observed incidence of antibody (including neutralizing antibody) positivity in an assay may be influenced by several factors, including assay methodology, sample handling, timing of sample collection, concomitant medications, and underlying disease. For these reasons, comparison of the incidence of antibodies to pegfilgrastim in the studies described below with the incidence of antibodies in other studies or to other products may be misleading.

Binding antibodies to pegfilgrastim were detected using a BIAcore assay. The approximate limit of detection for this assay is 500 ng/mL. Pre-existing binding antibodies were detected in approximately 6% (51/849) of patients with metastatic breast cancer. Four of 521 pegfilgrastim-treated subjects who were negative at baseline developed binding antibodies to pegfilgrastim following treatment. None of these 4 patients had evidence of neutralizing antibodies detected using a cell-based bioassay.

6.3        Postmarketing Experience

The following adverse reactions have been identified during post approval use of Neulasta. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. 

  •       Splenic rupture and splenomegaly (enlarged spleen) [see Warnings and Precautions (5.1)]
  •       Acute respiratory distress syndrome (ARDS) [see Warnings and Precautions (5.2)]
  •       Allergic reactions/hypersensitivity, including anaphylaxis, skin rash, urticaria, generalized erythema, and flushing [see Warnings and Precautions (5.3)]
  •       Sickle cell crisis [see Warnings and Precautions (5.5)]
  •       Glomerulonephritis [see Warnings and Precautions (5.6)]
  •       Leukocytosis [see Warnings and Precautions (5.7)]
  •       Capillary Leak Syndrome [see Warnings and Precautions (5.8)]
  •       Injection site reactions
  •       Sweet’s syndrome (acute febrile neutrophilic dermatosis), cutaneous vasculitis
  •       Application site reactions (including events such as application site hemorrhage, application site pain, application site discomfort, application site bruise, and application site erythema) have been reported with the use of the on-body injector for Neulasta.
  •       Contact dermatitis and local skin reactions such as rash, pruritus, and urticaria have been reported with the use of the on-body injector for Neulasta, possibly indicating a hypersensitivity reaction to the adhesive.
  •       Aortitis [see Warnings and Precautions (5.11)]
  •       Alveolar hemorrhage

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