Indication

Neulasta® (pegfilgrastim) is indicated to decrease the incidence of infection, as manifested by febrile neutropenia, in patients with nonmyeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a clinically significant incidence of febrile neutropenia... Read More
Neulasta® is not indicated for the mobilization of peripheral blood progenitor cells for hematopoietic stem cell transplantation.

On-body Injector Patient Instructions for Use:

Which version of the Instructions for Use did your doctors's office give you?

If you don’t recognize the images above or if you prefer a physical copy, contact your doctor.

Onpro® Kit HCP Instructions for Use:

Which version of the HCP Instructions for Use came with your patient's on-body injector?

Only Neulasta® Onpro® is designed to automatically deliver G-CSF therapy at the right time to reduce the risk of febrile neutropenia (FN)*

*Do not administer Neulasta® between 14 days before and 24 hours after administration of cytotoxic chemotherapy.

Neulasta® HCPCS code effective 1/1/2022: J2506—Injection, pegfilgrastim, 0.5 mg

Neulasta® Onpro® is designed for next-day G-CSF delivery

Onpro® is an on-body injector for Neulasta®

onpro-png

Onpro® is designed to automatically deliver Neulasta® 27 hours after application

See instructions

Incomplete doses have been reported with Neulasta® Onpro® due to the device not performing as intended. This may increase risk of neutropenia, FN, and/or infection.

Also available in prefilled syringe for manual injection

  • Both options offer a single, 6-mg fixed dose of Neulasta® with a half-life of 15-80 hours
  • Do not administer Neulasta® between 14 days before and 24 hours after administration of chemotherapy

Neulasta® Onpro® is available at no extra cost beyond that of the Neulasta® prefilled syringe

Special Instructions for the On-body Injector (OBI) for Neulasta®

For more information regarding dosing, please see the Neulasta® full Prescribing Information.

G-CSF = granulocyte colony-stimulating factor.

View comparable Neulasta® pharmacokinetics with on-body injector and prefilled syringe

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Application

4 steps to apply Neulasta® Onpro®

Photo: preparing the application site

Prepare the
application site

Photo: filling the on-body injector at 90-degree angle

Fill the on-body
injector

Photo: confirming status with visual and sound

Confirm on-body
injector status

Photo: applying the on-body injector

Apply the on-body
injector

The information provided does not replace the Healthcare Provider Instructions for
Use. Prior to use, please review the Instructions for Use.


See how to apply Neulasta® Onpro®

Image of video player for application video

This video does not replace the Instructions for Use. Please consult the
Instructions for Use when using the Neulasta® Onpro® kit.


Get to know Neulasta® Onpro® through an
interactive learning experience

Image of video player for interactive learning tool

Designed for oncology nurses, the tool offers hands-on digital simulations. It does not replace the Healthcare Provider Instructions for Use. Always refer to the Instructions for Use when using Neulasta® Onpro®.

PodPals™ are available for patients requiring additional adhesive support

chemo-png

If additional adhesion is deemed appropriate, an adhesive extender that fits around the on-body injector can be obtained.

Visit: NeulastaPodPals.com
Call: 1-844-MYNEULASTA (1-844-696-3852)(1-844-696-3852)

(Select option 2, then option 3)

Neulasta® mechanism of action

Neulasta® is a recombinant G-CSF that acts on hematopoietic cells and binds to specific cell surface receptors to stimulate production of neutrophils.2

Video player for mechanism of action video

Loratadine may help alleviate bone pain3

Bone pain was the most common adverse event for Neulasta®2

Neulasta® stimulates neutrophil development in the bone marrow, which may lead to bone pain for some patients.2,4-6

Adverse reactions with ≥ 5% higher incidence in Neulasta® patients compared with placebo2
Event Placebo (n = 461) Neulasta® 6 mg SC on day 2 (n = 467)
Bone pain 26% 31%
Pain in extremity 4% 9%

Taxane therapy may be associated with bone pain.3

Treatment with loratadine may be considered to help prevent bone pain in patients receiving chemotherapy and pegfilgrastim.4

Randomized, phase 2 study to estimate the effect of prophylactic naproxen or loratadine versus no prophylactic treatment on bone pain in patients with early-stage breast cancer receiving chemotherapy and pegfilgrastim. The primary endpoint of the study was bone pain (all grades combined) in cycle 1, captured as part of AE reporting.4

SC = subcutaneous; AE = adverse event.

The on-body injector is designed to deliver the same Neulasta®

Comparable Neulasta® pharmacokinetics with the prefilled syringe (PFS) for manual injection and on-body injector1

chart-mean-sd-neulasta-serum-concentration chart-mean-sd-neulasta-serum-concentration

PFS = prefilled syringe; SD = standard deviation.

Study design: Phase 1, randomized, open-label study of Neulasta® pharmacokinetics in healthy subjects at 5 controlled study centers. Subjects were randomized to receive a single, 6-mg dose of Neulasta® by hand using the PFS for manual injection (n = 128) or automatically using the on-body injector (n = 125). Primary endpoints were the maximum Neulasta® concentration and area under the concentration curve from time 0 to infinity after dosing.1

Important Safety Information

Contraindication

  • Neulasta® (pegfilgrastim) is contraindicated in patients with a history of serious allergic reactions to pegfilgrastim or filgrastim
  • Reactions have included anaphylaxis

Splenic Rupture

  • Splenic rupture, including fatal cases, can occur following the administration of Neulasta®
  • Evaluate for an enlarged or ruptured spleen in patients who report left upper abdominal or shoulder pain

Acute Respiratory Distress Syndrome (ARDS)

  • ARDS has occurred in patients receiving Neulasta®
  • Evaluate patients who develop a fever and lung infiltrates or respiratory distress after receiving Neulasta®
  • Discontinue Neulasta® in patients with ARDS

Serious Allergic Reactions

  • Serious allergic reactions, including anaphylaxis can occur in patients receiving Neulasta®
  • Majority of events occurred upon initial exposure and can recur within days after discontinuation of initial anti-allergic treatment
  • Permanently discontinue Neulasta® in patients with serious allergic reactions

Allergies to Acrylics

  • On-body injector (OBI) for Neulasta® uses acrylic adhesives
  • Patients who are allergic to acrylic adhesives may have a significant reaction

Use in Patients With Sickle Cell Disorders

  • In patients with sickle cell trait or disease, severe and sometimes fatal sickle cell crises can occur in patients receiving Neulasta®
  • Discontinue Neulasta® if sickle cell crisis occurs

Glomerulonephritis

  • Has occurred in patients receiving Neulasta®
  • Diagnoses based on azotemia, hematuria, proteinuria, and renal biopsy
  • Generally events resolved after dose reduction or discontinuation of Neulasta®
  • If suspected, evaluate for cause and if cause is likely, consider dose-reduction or interruption of Neulasta®

Leukocytosis

  • Increased white blood cell counts of 100 x 109/L have been observed
  • Monitoring of complete blood count (CBC) during pegfilgrastim therapy is recommended

Thrombocytopenia

  • Thrombocytopenia has been reported in patients receiving pegfilgrastim. Monitor platelet counts

Capillary Leak Syndrome (CLS)

  • CLS has been reported after G-CSF administration, including Neulasta®
  • Characterized by hypotension, hypoalbuminemia, edema, and hemoconcentration
  • Episodes vary in frequency, severity, and may be life-threatening if treatment is delayed
  • Patients with symptoms should be closely monitored and receive standard symptomatic treatment, which may include intensive care

Potential for Tumor Growth Stimulatory Effects on Malignant Cells

  • G-CSF receptor has been found on tumor cell lines
  • The possibility that pegfilgrastim acts as a growth factor for any tumor type, including myeloid malignancies and myelodysplasia, diseases for which Neulasta® is not approved, cannot be excluded

Myelodysplastic Syndrome (MDS) and Acute Myeloid Leukemia (AML) in Patients With Breast and Lung Cancer

  • MDS and AML have been associated with the use of Neulasta® in conjunction with chemotherapy and/or radiotherapy in patients with breast and lung cancer. Monitor patients for signs and symptoms of MDS/AML in these settings

Potential Device Failures

  • Missed or partial doses have been reported in patients receiving pegfilgrastim via the on-body injector (OBI) due to the device not performing as intended
  • In the event of a missed or partial dose, patients may be at increased risk of events such as neutropenia, febrile neutropenia and/or infection than if the dose had been correctly delivered
  • Instruct patients to notify their healthcare professional immediately in order to determine the need for a replacement dose if they suspect that the device may not have performed as intended

Aortitis

  • Aortitis has been reported in patients receiving Neulasta®. It may occur as early as the first week after start of therapy
  • Manifestations may include generalized signs and symptoms such as fever, abdominal pain, malaise, back pain, and increased inflammatory markers (e.g., c-reactive protein and white blood cell count)
  • Consider aortitis in patients who develop these signs and symptoms without known etiology. Discontinue Neulasta® if aortitis is suspected

Nuclear Imaging

  • Increased hematopoietic activity of the bone marrow in response to growth factor therapy has been associated with transient positive bone imaging changes. This should be considered when interpreting bone imaging results

Most common adverse reactions

  • Bone pain
  • Pain in extremity

Please see Neulasta® full Prescribing Information.

Neulasta® Injection: 6 mg/0.6 mL in a single-dose prefilled syringe for manual use only.

Neulasta® Injection: 6 mg/0.6 mL in a single-dose prefilled syringe co-packaged with the on-body injector (OBI) for Neulasta® (Neulasta® Onpro® kit).

Special Instructions for the On-body Injector (OBI) for Neulasta®

A healthcare provider must fill the on-body injector (OBI) with Neulasta® using the co-packaged prefilled syringe and then apply the OBI to the patient’s skin (abdomen or back of arm). The back of the arm may only be used if there is a caregiver available to monitor the status of the OBI. Approximately 27 hours after the OBI is applied to the patient’s skin, Neulasta® will be delivered over approximately 45 minutes. A healthcare provider may initiate administration with the OBI on the same day as the administration of cytotoxic chemotherapy, as long as the OBI delivers Neulasta® no less than 24 hours after the administration of cytotoxic chemotherapy.

The prefilled syringe co-packaged in the Neulasta® Onpro® kit contains additional solution to compensate for liquid loss during delivery through the OBI. If this syringe is used for manual subcutaneous injection, the patient will receive an overdose. If the prefilled syringe for manual use is used with the OBI, the patient may receive less than the recommended dose.

Do not use the OBI to deliver any other drug product except the Neulasta® prefilled syringe co-packaged with the OBI. Use of the OBI has not been studied in pediatric patients.

The OBI should be applied to intact, non-irritated skin on the arm or abdomen.

A missed dose could occur due to an OBI failure or leakage. Instruct patients using the OBI to notify their healthcare professional immediately in order to determine the need for a replacement dose of pegfilgrastim if they suspect that the device may not have performed as intended. If the patient misses a dose, a new dose should be administered by single prefilled syringe for manual use as soon as possible after detection.

Review the Patient Information and Patient Instructions for Use with the patient and provide the instructions to the patient.

Refer to the Healthcare Provider Instructions for Use for the OBI for full administration information.

For any OBI problems, call Amgen at 1-800-772-6436 1-800-772-6436 or 1-844-MYNEULASTA (1-844-696-3852). 1-844-MYNEULASTA (1-844-696-3852).

References:
1. Yang BB, et al. Cancer Chemother Pharmacol. 2015;75:1199-1206. 2. Neulasta® (pegfilgrastim) Prescribing Information, Amgen. 3. Kirshner JJ, et al. Support Care Cancer. 2018;26:1323-1334. 4. Yang BB, et al. Clin Pharmacokinet. 2011;50:295-306. 5. Haegerstam GA. Acta Orthop Scand. 2001;72:308-317. 6. Schweizerhof M, et al. Nat Med. 2009;15:802-807.

References:
1. Data on file, Amgen; 2021. 2. Data on file, Amgen; 2020. 3. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Myeloid Growth Factors V.1.2021. ©National Comprehensive Cancer Network, Inc. 2021. All rights reserved. Accessed April 25, 2021. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. 4. Smith TJ, et al. J Clin Oncol. 2015;33:3199-3212. 5. Martin M, et al. N Engl J Med. 2005;352:2302-2313. 6. Younis T, et al. Support Care Cancer. 2012;20:2523-2530. 7. Perjeta (pertuzumab) Prescribing Information, Genentech, Inc. 8. Schneeweiss A, et al. Ann Oncol. 2013;24:2278-2284. 9. Cerchione C, et al. Support Care Cancer. 2017;25:839-845. 10. Ösby E, et al. Blood. 2003;101:3840-3848. 11. Delarue R, et al. Lancet Oncol. 2013;14:525-533. 12. Ohe Y, et al. Ann Oncol. 2007;18:317-323. 13. Swain SM, et al. N Engl J Med. 2010;362:2053-2065. 14. Schiller JH, et al. N Engl J Med. 2002;346:92-98. 15. Yoshimura N, et al. J Thorac Oncol. 2009;4:371-375. 16. Kongsted P, et al. Urol Oncol. 2015;33:494.e15-494.e20. doi:10.1016/j.urolonc.2015.06.022. 17. Vogel CL, et al. J Clin Oncol. 2005;23:1178-1184. 18. Moreau M, et al. Ann Oncol. 2009;20:513-519. 19. Lyman GH, et al. Leuk Lymphoma. 2003;44:2069-2076. 20. Lyman GH, et al. J Clin Oncol. 2004;22:4302-4311. 21. Klastersky J, et al. J Clin Oncol. 2000;18:3038-3051. 22. Chao C, et al. Ann Oncol. 2014;25:1821-1829. 23. Takenaka Y, et al. Support Care Cancer. 2013;21:2861-2868. 24. Shayne M, et al. Cancer. 2007;110:1611-1620. 25. Intragumtornchai T, et al. Leuk Lymphoma. 2000;37:351-360. 26. Family L, et al. J Clin Oncol. 2016;34. Abstract 6559. 27. Pettengell R, et al. Br J Haematol. 2008;144:677-685. 28. American Cancer Society. Watching for and Preventing Infections. https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/low-blood-counts/infections/preventing-infections-in-people-with-cancer.html. Accessed December 20, 2021. 29. Neulasta® (pegfilgrastim) Prescribing Information, Amgen.

References:
1. Data on file, Amgen; 2021. 2. Mahtani RL, et al. A multicenter, prospective, observational study to determine the incidence of febrile neutropenia (FN), persistence and G-CSF utilization among cancer patients at high risk for FN receiving pegfilgrastim by an on-body injector (OBI) versus other FN-prophylaxis strategies. Poster presented at: San Antonio Breast Cancer Symposium®, Virtual. 3. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Myeloid Growth Factors V.1.2021. ©National Comprehensive Cancer Network, Inc. 2021. All rights reserved. Accessed April 5, 2021. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. 4. Data on file, Amgen; 2020. 5. Lyman GH. J Natl Comr Canc Netw. 2009;7:2612-2615.

Reference:
1. Data on file, Amgen; 2021.

References:
1. Data on file, Amgen; [1]; 2020. 2. Data on file, Amgen; [2]; 2020. 3. Data on file, Amgen; [3]; 2020. 4. Data on file, Amgen; 2016. 5. Vogel CL, et al. J Clin Oncol. 2005;23(6):1178-1184.

Reference:
1. Vogel CL, et al. J Clin Oncol. 2005;23(6):1178-1184.

Important Safety Information

Contraindication

  • Neulasta® (pegfilgrastim) is contraindicated in patients with a history of serious allergic reactions to pegfilgrastim or filgrastim
  • Reactions have included anaphylaxis

Splenic Rupture

  • Splenic rupture, including fatal cases, can occur following the administration of Neulasta®
  • Evaluate for an enlarged or ruptured spleen in patients who report left upper abdominal or shoulder pain

Acute Respiratory Distress Syndrome (ARDS)

  • ARDS has occurred in patients receiving Neulasta®
  • Evaluate patients who develop a fever and lung infiltrates or respiratory distress after receiving Neulasta®
  • Discontinue Neulasta® in patients with ARDS

Serious Allergic Reactions

  • Serious allergic reactions, including anaphylaxis can occur in patients receiving Neulasta®
  • Majority of events occurred upon initial exposure and can recur within days after discontinuation of initial anti-allergic treatment
  • Permanently discontinue Neulasta® in patients with serious allergic reactions

Allergies to Acrylics

  • On-body injector (OBI) for Neulasta® uses acrylic adhesives
  • Patients who are allergic to acrylic adhesives may have a significant reaction

Use in Patients With Sickle Cell Disorders

  • In patients with sickle cell trait or disease, severe and sometimes fatal sickle cell crises can occur in patients receiving Neulasta®
  • Discontinue Neulasta® if sickle cell crisis occurs

Glomerulonephritis

  • Has occurred in patients receiving Neulasta®
  • Diagnoses based on azotemia, hematuria, proteinuria, and renal biopsy
  • Generally events resolved after dose reduction or discontinuation of Neulasta®
  • If suspected, evaluate for cause and if cause is likely, consider dose-reduction or interruption of Neulasta®

Leukocytosis

  • Increased white blood cell counts of 100 x 109/L have been observed
  • Monitoring of complete blood count (CBC) during pegfilgrastim therapy is recommended

Thrombocytopenia

  • Thrombocytopenia has been reported in patients receiving pegfilgrastim. Monitor platelet counts

Capillary Leak Syndrome (CLS)

  • CLS has been reported after G-CSF administration, including Neulasta®
  • Characterized by hypotension, hypoalbuminemia, edema, and hemoconcentration
  • Episodes vary in frequency, severity, and may be life-threatening if treatment is delayed
  • Patients with symptoms should be closely monitored and receive standard symptomatic treatment, which may include intensive care

Potential for Tumor Growth Stimulatory Effects on Malignant Cells

  • G-CSF receptor has been found on tumor cell lines
  • The possibility that pegfilgrastim acts as a growth factor for any tumor type, including myeloid malignancies and myelodysplasia, diseases for which Neulasta® is not approved, cannot be excluded

Myelodysplastic Syndrome (MDS) and Acute Myeloid Leukemia (AML) in Patients With Breast and Lung Cancer

  • MDS and AML have been associated with the use of Neulasta® in conjunction with chemotherapy and/or radiotherapy in patients with breast and lung cancer. Monitor patients for signs and symptoms of MDS/AML in these settings

Potential Device Failures

  • Missed or partial doses have been reported in patients receiving pegfilgrastim via the on-body injector (OBI) due to the device not performing as intended
  • In the event of a missed or partial dose, patients may be at increased risk of events such as neutropenia, febrile neutropenia and/or infection than if the dose had been correctly delivered
  • Instruct patients to notify their healthcare professional immediately in order to determine the need for a replacement dose if they suspect that the device may not have performed as intended

Aortitis

  • Aortitis has been reported in patients receiving Neulasta®. It may occur as early as the first week after start of therapy
  • Manifestations may include generalized signs and symptoms such as fever, abdominal pain, malaise, back pain, and increased inflammatory markers (e.g., c-reactive protein and white blood cell count)
  • Consider aortitis in patients who develop these signs and symptoms without known etiology. Discontinue Neulasta® if aortitis is suspected

Nuclear Imaging

  • Increased hematopoietic activity of the bone marrow in response to growth factor therapy has been associated with transient positive bone imaging changes. This should be considered when interpreting bone imaging results

Most common adverse reactions

  • Bone pain
  • Pain in extremity

Please see Neulasta® full Prescribing Information.

Neulasta® Injection: 6 mg/0.6 mL in a single-dose prefilled syringe for manual use only.

Neulasta® Injection: 6 mg/0.6 mL in a single-dose prefilled syringe co-packaged with the on-body injector (OBI) for Neulasta® (Neulasta® Onpro® kit).

Special Instructions for the On-body Injector (OBI) for Neulasta®

A healthcare provider must fill the on-body injector (OBI) with Neulasta® using the co-packaged prefilled syringe and then apply the OBI to the patient’s skin (abdomen or back of arm). The back of the arm may only be used if there is a caregiver available to monitor the status of the OBI. Approximately 27 hours after the OBI is applied to the patient’s skin, Neulasta® will be delivered over approximately 45 minutes. A healthcare provider may initiate administration with the OBI on the same day as the administration of cytotoxic chemotherapy, as long as the OBI delivers Neulasta® no less than 24 hours after the administration of cytotoxic chemotherapy.

The prefilled syringe co-packaged in the Neulasta® Onpro® kit contains additional solution to compensate for liquid loss during delivery through the OBI. If this syringe is used for manual subcutaneous injection, the patient will receive an overdose. If the prefilled syringe for manual use is used with the OBI, the patient may receive less than the recommended dose.

Do not use the OBI to deliver any other drug product except the Neulasta® prefilled syringe co-packaged with the OBI. Use of the OBI has not been studied in pediatric patients.

The OBI should be applied to intact, non-irritated skin on the arm or abdomen.

A missed dose could occur due to an OBI failure or leakage. Instruct patients using the OBI to notify their healthcare professional immediately in order to determine the need for a replacement dose of pegfilgrastim if they suspect that the device may not have performed as intended. If the patient misses a dose, a new dose should be administered by single prefilled syringe for manual use as soon as possible after detection.

Review the Patient Information and Patient Instructions for Use with the patient and provide the instructions to the patient.

Refer to the Healthcare Provider Instructions for Use for the OBI for full administration information.

For any OBI problems, call Amgen at 1-800-772-6436 1-800-772-6436 or 1-844-MYNEULASTA (1-844-696-3852). 1-844-MYNEULASTA (1-844-696-3852).