Abstract:

Objective To compare the efficacy, safety and pharmacoeconomics of mecapegfilgrastim and efbemalenograstim alfa in the management of chemotherapy-induced neutropenia (CIN) in cancer patients, and to perform a subgroup analysis stratified by chemotherapy regimen risk, thereby providing evidence-based support for rational clinical drug selection. Methods A retrospective cohort study was conducted, enrolling 163 patients with malignant tumors who developed CIN after chemotherapy. Patients were divided into the mecapegfilgrastim group (n=77) and the efbemalenograstim alfa injection group (n=86). The incidence of adverse reactions after medication, incidence of grade ≥3 CIN，febrile neutropenia (FN) and treatment costs were compared between the two groups. Results In terms of safety, the overall AE rate (particularly fatigue) in the mecapegfilgrastim group was significantly lower than that in the efbemalenograstim alfa group. For efficacy, the efbemalenograstim alfa group exhibited a significantly lower incidence of grade ≥3 CIN in the first chemotherapy cycle, but no significant differences were observed in FN incidence during cycles 2-4 or overall between the two groups. Pharmacoeconomic analysis revealed no significant differences in the number of additional short-acting granulocyte colony-stimulating factor (G-CSF) injection or blood test frequency. However, the hospitalization costs were significantly reduced in the mecapegfilgrastim group. Subgroup analysis by chemotherapy regimen risk showed that fatigue was more prevalent in the efbemalenograstim alfa group in the high-risk regimen subgroup, while hospitalization costs were consistently lower in the mecapegfilgrastim group. For high-risk regimens, efbemalenograstim alfa demonstrated superior efficacy in the first cycle, whereas mecapegfilgrastim performed better in cycles 2-4. For medium-risk regimens, the efficacy of the two agents was comparable. Conclusion Efbemalenograstim alfa has a faster initial onset of action (especially in high-risk regimens), but it is associated with more adverse effects such as fatigue. Mecapegfilgrastim offers better long-term safety and lower hospitalization costs.

Key words: chemotherapy-induced febrile neutropenia, Filgrastim, Mecapegfilgrastim, Efbemalenograstim alfa