Descriptive Analysis of Filgrastim use in children in Quebec’s University Teaching Hospitals, Canada.

Ghislain Berard, Cathy Quirion, Chantal Guevremont, Jean-Francois Delisle,Elaine Pelletier, Nathalie Marcotte, Marie-Claude Michel, France Varin, Paul Farand, Raghu Rajan, Philippe Ovetchkine, Louise Deschesne, Daniel Froment, Monia Marzouki

CIUSSS de l’Estrie – CHUS, Sherbrooke, Canada, McGill University Health Centre, Montreal, Canada, Centre hospitalier universitaire Sainte-Justine, Montreal, Canada, CHU de Quebec Universite Laval, Que ´bec, Canada, Centre hospitalier de l’Universite de Montreal, Montre al, Canada, Programme de gestion therapeutique des medicaments, Canada

Background: Filgrastim use in primary prophylaxis of febrile neutropenia in children is generally guided by specific research protocols. Its use in febrile neutropenia treatment for this population is also common.

Objective/Purpose: Describe filgrastim use in the pediatric population.

Study Design/Methods: Retrospectively, 175 episodes of care in 148 patients who received filgrastim between 1 August 2014 and 31 July 2015 were chosen randomly and reviewed.

Results/Key findings: Filgrastim was used in 79 episodes for primary prophylaxis, 6 for secondary prophylaxis and 42 for febrile neutropenia. In all but four episodes of primary prophylaxis, filgrastim was given as part of a clinical study or a protocol identical to a closed study. All were for patients that received chemotherapy at high or moderate risk of febrile neutropenia. In the 42 episodes of febrile neutropenia, mean hospitalisation stay was 25.9 days and mean filgrastim use was 5.7 days. At least one factor for poor clinical outcome was identified in 30 of these episodes. Absolute neutrophil count was above 1.9 x 10e9/L in 14 episodes when filgrastim was stopped.

Conclusion/Recommendations: Tools to help clinicians with filgrastim prescription outside of clinical research protocols (pre-printed order, febrile neutropenia guidelines, standardised absolute neutrophil count for filgrastim discontinuation) should be developed to optimize its use.

Reference: Selected abstracts presented at the Canadian Association of Pharmacy in Oncology (CAPhO) Conference 2019 taking place from 25–28 April 2019, in Halifax, Nova Scotia.

Oseltamivir combined with HIV drugs lopinavir and ritonavir the medications improved conditions in patients with severe 2019-nCoV infections, say doctors in Thailand.

A combination of flu and HIV medications may be able to treat severe cases of 2019-nCoV, the new coronavirus that has emerged in China, according to doctors in Thailand who have been caring for infected patients. The team’s approach, which used large doses of the flu drug Oseltamivir combined with HIV drugs lopinavir and ritonavir, improved the conditions of several patients at the Rajavithi Hospital in Bangkok.

“This is not the cure, but the patient’s condition has vastly improved,” Rajavithi Hospital’s Kriangsak Atipornwanich says of one 70-year-old Chinese woman from Wuhan, according to Reuters. “From testing positive for 10 days under our care, after applying this combination of medicine the test result became negative within 48 hours.”

Thailand has so far recorded 19 cases of coronavirus, Reuters reports, making it the country with the greatest number of infections in Southeast Asia. Eight patients have recovered, while the rest are still undergoing treatment. Officials say that the country’s health ministry would meet today (February 3) to discuss the new treatment for severe cases. “We still have to do more study to determine that this can be a standard treatment,” Atipornwanich tells reporters.

Other countries have also showed interest in using HIV drugs against the new coronavirus. China’s National Health Commission recently began recommending lopinavir and ritonavir (sold together by Illinois-based pharma AbbVie as Kaletra), according to Fierce Pharma. AbbVie has pledged to donate about $1.5 million worth of Kaletra for the effort.

A randomized controlled clinical trial is now underway in China to test the anti-HIV drugs’ efficacy, according to a study published last week (January 24) in The Lancet. Scientists in Hong Kong will also likely test these drugs in patients alongside immune system–boosting medications, Hong Kong University microbiologist Yuen Kwok-Yung tells Science.

Other treatments being considered by national governments and pharma companies include Gilead Sciences’s remdesivir, a drug that was designed to treat Ebola but failed efficacy tests. “Gilead is working closely with global health authorities to respond to the novel coronavirus (2019-nCoV) outbreak through the appropriate experimental use of our investigational compound remdesivir,” the company’s Chief Medical Officer Merdad Parsey says in a statement.

Massachusetts-based Moderna Therapeutics, meanwhile, is collaborating with the US National Institute of Allergy and Infectious Diseases to develop an mRNA vaccine, Fierce Pharma reports.

Catherine Offord is an associate editor at The Scientist. Email her at cofford@the-scientist.com.