Romeo Cristina, Li Quan, Copeland Larry
College of Pharmacy, The Ohio State University, Columbus, OH, USA.
James Cancer Hospital, The Ohio State University, Columbus, OH, USA
J Oncol Pharm Pract. 2015 Aug;21(4):301-4. doi: 10.1177/1078155214527858. Epub 2014 Mar 24.
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.
发热性中性粒细胞减少是一种可能导致严重后果的肿瘤急症。粒细胞集落刺激因子（G-CSF）常被用作发热性中性粒细胞减少的预防药物。骨痛是G-CSF引起的最广为人知的不良反应。具体而言，对于培非格司亭（Neulasta(®)），实际中骨痛的发生率高于临床试验期间观察到的发生率。传统镇痛药，如非甾体抗炎药（NSAIDs）和阿片类药物，对培非格司亭引起的严重骨痛可能无效。鉴于这种不良反应的高发生率，显然医疗从业者需要为经历培非格司亭引起的严重骨痛的患者提供更多治疗选择。G-CSF继发骨痛的机制尚不完全清楚，但研究表明组胺释放参与了炎症过程。以前关于使用抗组胺药治疗G-CSF引起的疼痛的临床数据很少。我们报告了首例病例，其中氯雷他定预防完全缓解了培非格司亭继发的对NSAIDs耐药的严重疼痛。结果表明，氯雷他定可能是治疗培非格司亭引起的严重、耐药性骨痛的一个有前景的选择。有必要且正在进行进一步的临床研究。
