Effects of dual histamine blockade on filgrastim induced bone pains in female cancer patients: single institutional analysis

Purpose: Bone pain is the commonest side-effect faced by cancer patients receiving Granulocyte Colony Stimulating Factor (G-CSF) therapy for the primary or secondary prevention of febrile neutropenia. We conducted a prospective quasi-experimental study at our setup to see the efficacy of dual histamine blockade (combined H1 and H2 blockers) for preventing G-CSF-induced bone pains. Methods: Adult female patients with solid tumors who had received Filgrastim for the primary prophylaxis of febrile neutropenia and met our inclusion criteria, were enrolled (n= 119). This population was analyzed for the development of significant bone pains 24 hours after the administration of Filgrastim. Significant bone pain in our study was defined as emergence of new onset pain measuring ≥4 on 11-point Numerical rating scale (NRS) or at least ≥ 2-point increase in score when compared to the baseline pain (if any). Those patients who experienced significant bone pains (n=47) were given Loratadine 10 mg and Famotidine 20 mg orally half an hour before the next Filgrastim administration. Pain assessment was done 24 hours after Filgrastim administration, using NRS and data was analyzed. Results: The mean NRS score in our patients after administration of Filgrastim was 6.87±1.055. Most of these patients (81%) experienced relief in bone pains after dual histamine blockade use. The mean NRS score after the use of dual antihistamine blockade was 4.36±1.870. The NRS score improved by a mean of 2.51 after using dual histamine blockade, which was statistically significant (p-value= 0.0005). Conclusion: We propose that dual antihistamine blockade may prove to be an effective option for prophylaxis of G-CSF-induced-bone-pains. Randomized control trials on larger and more diverse patient populations are required to reinforce the findings.