Filgrastim (Ratiograstim®) is recommended as an option for use within NHS Wales in the treatment of neutropenia:

• For the reduction in the duration of neutropenia and the incidence of febrile neutropenia in patients treated with established cytotoxic chemotherapy for malignancy (with the exception of chronic myeloid leukaemia and myelodysplastic syndromes) and for the reduction in the duration of neutropenia in patients undergoing myeloablative therapy followed by bone marrow transplantation considered to be at increased risk of prolonged severe neutropenia.
• For the mobilisation of peripheral blood progenitor cells (PBPC).
• To increase neutrophil counts and to reduce the incidence and duration of infection-related events in patients with severe congenital, cyclic, or idiopathic neutropenia with an absolute neutrophil count (ANC) of 0.5 x 10⁹/L, and a history of severe or recurrent infections.
• For the treatment of persistent neutropenia (ANC less than or equal to 1.0 x 10⁹/L) in patients with advanced human immunodeficiency virus (HIV) infection, in order to reduce the risk of bacterial infections when other options to manage neutropenia are inappropriate.

AWMSG is of the opinion that filgrastim (Ratiograstim®) is not suitable for shared care within NHS Wales. Biosimilars should be prescribed by brand name to avoid automatic substitution and ensure consistency in provision.