Naproxen May Relieve Bone Pain Associated with Neulasta

Twice-daily naproxen is effective in reducing the incidence and severity of bone pain associated with the use of Neulasta® (pegfilgrastim), according to the results of a study published in the Journal of Clinical Oncology.

Neulasta is a blood cell growth factor that can be an important addition to the chemotherapy regimen for many patients. Although chemotherapy improves outcomes for many cancer patients, it is associated with unpleasant and sometimes life-threatening side effects, including neutropenia, which occurs when white blood cells (immune cells) are destroyed by chemotherapy, leaving the immune system unable to fight infections. Neulasta is given by injection during chemotherapy cycles and can reduce infections, hospitalizations, medical cost, dose delays, and death associated with infection in neutropenic patients.

Neulasta is important because it can help patients continue to receive chemotherapy at the prescribed dose and schedule, which offers the best chance for cure. Unfortunately, Neulasta can induce bone pain—and this becomes a significant clinical problem because it can lead to discontinuation of the drug, which can potentially lead to reduced chemotherapy dosing, which can compromise the chance of cure.

Naproxen is a prescription pain reliever in a class of drugs called non-steroidal anti-inflammatory drugs or NSAIDs. It works by stopping the body’s production of a substance that causes pain, fever, and inflammation.

To evaluate the effects of naproxen on Neulasta-induced bone pain, researchers randomly assigned 510 patients to receive naproxen (500 mg, twice a day) or placebo on the day of Neulasta injection and continuing for five to eight days afterward. Patients recorded pain severity and duration on a daily basis.

The results indicated that pain reached its peak on day three for both groups, but was higher in the placebo group. Overall, the incidence and severity of pain was higher in the placebo group. The researchers concluded that naproxen reduced the incidence, duration, and severity of Neulasta-induced pain; however, even with the preventive treatment, more than 60 percent of patients experienced some pain. More strategies are needed to address bone pain associated with Neulasta, but naproxen appears to be one viable strategy.


Kirshner JJ, Heckler CE, Janelsins MC, et al. Prevention of pegfilgrastim-induced bone pain: A phase III double-blind placebo-controlled randomized clinical trial of the University of Rochester Cancer Center Clinical Community Oncology Program Research Base. Journal of Clinical Oncology. 2012; 16: 1974-1979.

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