Use of Niraparib in Ovarian Cancer: Benefits of an Individualized Starting Dose

By: Victoria Kuhr, MS
Posted: Wednesday, January 29, 2025

The phase III, randomized, double-blind, placebo-controlled PRIMA trial found that individualized starting dose of the PARP inhibitor niraparib may reduce side effects and treat patients with ovarian cancer similarly when compared with a fixed starting dose. Additionally, Whitney S. Graybill, MD, of the Medical University of South Carolina, Charleston, and colleagues observed that for niraparib, the cost of managing hematologic adverse events in the United States was reduced by almost half with the individualized starting dose vs the fixed starting dose. These findings were published in the Journal of Comparative Effectiveness Research.

This study evaluated fixed and individualized starting doses of niraparib as first-line maintenance therapy for patients with newly diagnosed advanced epithelial ovarian cancer that responded to first-line platinum-based chemotherapy. The cost analysis included grade ≥ 3 hematologic adverse events that occurred in at least 1% of patients treated with niraparib. The U.S. unit costs for hospital-related management of each adverse event were obtained from the 2017 Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project National Inpatient Sample database. Unit costs were adjusted to 2020 U.S. dollars.

The niraparib fixed starting dose was associated with grade ≥ 3 treatment-emergent adverse events of thrombocytopenia, anemia, and neutropenia, with a high incidence of treatment-emergent adverse events resulting in dose reduction. The estimated adverse event management cost per patient was lower for the individualized vs fixed starting dose for all hematologic adverse events (thrombocytopenia, $1,921.89 vs $4,701.87; anemia, $1,760.59 vs $2,784.00; platelet count decreased, $922.51 vs $2,103.47; neutropenia, $1,369.56 vs $2,112.50; neutrophil count decreased, $770.38 vs $1,285.87). The total mean calculated adverse event management cost per patient was $12,987.71 with the fixed starting dose and $6,744.93 with the individualized starting dose. Implementation of an individualized starting dose for niraparib reduced the total cost of hematologic adverse event management by 48.1% vs the fixed starting dose, the authors noted.

Disclosure: For full disclosures of the study authors, visit becarispublishing.com.

Journal of Comparative Effectiveness Research

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