title: Severe pegfilgrastim-induced bone pain completely alleviated with loratadine: A case report.
abstract: Febrile neutropenia is an oncologic emergency that can result in serious consequences. Granulocyte colony stimulating factors (G-CSFs) are often used as prophylaxis for febrile neutropenia. Bone pain is the most notorious adverse effect caused by G-CSFs. Specifically, with pegfilgrastim (Neulasta(®)), the incidence of bone pain is higher in practice than was observed during clinical trials. Traditional analgesics, such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, can be ineffective in severe pegfilgrastim-induced bone pain. With the high frequency of this adverse effect, it is clear that health practitioners need additional treatment options for patients who experience severe pegfilgrastim-induced bone pain. The mechanisms of bone pain secondary to G-CSFs are not fully known, but research has shown that histamine release is involved in the inflammatory process. There is scant previous clinical data on antihistamine use in the management of G-CSF-induced pain. We present the first case report in which loratadine prophylaxis completely alleviated NSAID-resistant severe pain secondary to pegfilgrastim. The result showed that loratadine may be a promising option for severe, resistant pegfilgrastim-induced bone pain. Further clinical studies are warranted and ongoing.
authors.affiliation: College of Pharmacy, The Ohio State University, Columbus, OH, USA.
authors.forename: Cristina
authors.initials: C
authors.lastname: Romeo
authors.affiliation: James Cancer Hospital, The Ohio State University, Columbus, OH, USA Quan.Li@osumc.edu.
authors.forename: Quan
authors.initials: Q
authors.lastname: Li
authors.affiliation: College of Medicine, The Ohio State University, Columbus, OH, USA.
authors.forename: Larry
authors.initials: L
authors.lastname: Copeland
mesh_terms: D000368:Aged; D001847:Bone Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects*; D006801:Humans; D017336:Loratadine / Q000627:therapeutic use*; D009503:Neutropenia / Q000175:diagnosis / Q000188:drug therapy; D010146:Pain / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy*; D011092:Polyethylene Glycols; D011994:Recombinant Proteins / Q000009:adverse effects; D012720:Severity of Illness Index
chemical_list: D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; C455861:pegfilgrastim; D011092:Polyethylene Glycols; D017336:Loratadine; D000069585:Filgrastim
keywords: Granulocyte colony stimulating factor; antihistamine; bone pain; loratadine