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Granulocyte colony-stimulating factor for alcoholic hepatitis: A systematic review and meta-analysis of randomised controlled trials
Granulocyte colony-stimulating factor (G-CSF) treatment has been proposed as a therapeutic option for patients with severe alcoholic hepatitis (AH). The aim of this study was to synthesise available evidence on the efficacy of G-CSF in AH. This is a meta-analysis of randomised controlled trials eval...
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| Published in: | JHEP reports 2020-10, Vol.2 (5), p.100139-100139, Article 100139 |
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| creator | Marot, Astrid Singal, Ashwani K. Moreno, Christophe Deltenre, Pierre |
| description | Granulocyte colony-stimulating factor (G-CSF) treatment has been proposed as a therapeutic option for patients with severe alcoholic hepatitis (AH). The aim of this study was to synthesise available evidence on the efficacy of G-CSF in AH.
This is a meta-analysis of randomised controlled trials evaluating the risk of death at 90 days and the risk of infection.
Seven studies were included. Of a total of 396 patients, 336 had AH, 197 patients were treated with G-CSF, and 199 received placebo or pentoxifylline. In overall meta-analysis, G-CSF therapy was associated with a reduced risk of death at 90 days (odds ratio [OR] 0.28; 95% CI 0.09–0.88; p = 0.03). There was high heterogeneity between studies (p |
| doi_str_mv | 10.1016/j.jhepr.2020.100139 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_40cc9d0ce4614aac927a630f8e0cfe93</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S2589555920300732</els_id><doaj_id>oai_doaj_org_article_40cc9d0ce4614aac927a630f8e0cfe93</doaj_id><sourcerecordid>2432861426</sourcerecordid><originalsourceid>FETCH-LOGICAL-c525t-b1196615427aac47a616251a37607edd8e7434e52406abd8b79d516a86b64e683</originalsourceid><addsrcrecordid>eNp9UktuFDEQbSEQiUJOgIR6yaYH2-1PGwmkKIIQKRIbWFseu3rGI3d7sD1BcwDuwVk4GZWZECUbFlaVql695_o0zWtKFpRQ-W6z2KxhmxeMsLsIob1-1pwyMehOCKGfP_JPmvNSNoQQpjTH2pfNSc-UElqJ0-bXVbbzLia3r9C6FNO870oN0y7aGuZVO1pXU25HfDa6tE4xuBaVMVtDed9e_Pld9qXChAHXZrgN8LO1s28nqLazs437EkqbxhZ1fJpCAY86c80pRnRrDjaWV82LEQ2c39uz5vvnT98uv3Q3X6-uLy9uOieYqN2SUi0lFZwpax1XVlLJBLW9kkSB9wMo3nMQjBNpl35YKu0FlXaQS8lBDv1Zc33k9cluzDaHyea9STaYQyDllbEZG4lgOHFOe-KAS8pRTaOm7Mk4AHEj6B65Ph65trvlBN4B9mTjE9KnmTmszSrdGtVrOTCJBG_vCXL6sYNSDU7HQYx2hrQrhvGeDSh-gPZHqMuplAzjgwwl5u4ezMYc7sHc3YM53gNWvXn8w4eaf9tHwIcjAHDmuLlsigswO_Ahg6s4lPBfgb_Pt8vv</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2432861426</pqid></control><display><type>article</type><title>Granulocyte colony-stimulating factor for alcoholic hepatitis: A systematic review and meta-analysis of randomised controlled trials</title><source>ScienceDirect (Online service)</source><source>PubMed Central</source><creator>Marot, Astrid ; Singal, Ashwani K. ; Moreno, Christophe ; Deltenre, Pierre</creator><creatorcontrib>Marot, Astrid ; Singal, Ashwani K. ; Moreno, Christophe ; Deltenre, Pierre</creatorcontrib><description>Granulocyte colony-stimulating factor (G-CSF) treatment has been proposed as a therapeutic option for patients with severe alcoholic hepatitis (AH). The aim of this study was to synthesise available evidence on the efficacy of G-CSF in AH.
This is a meta-analysis of randomised controlled trials evaluating the risk of death at 90 days and the risk of infection.
Seven studies were included. Of a total of 396 patients, 336 had AH, 197 patients were treated with G-CSF, and 199 received placebo or pentoxifylline. In overall meta-analysis, G-CSF therapy was associated with a reduced risk of death at 90 days (odds ratio [OR] 0.28; 95% CI 0.09–0.88; p = 0.03). There was high heterogeneity between studies (p <0.001; I2 = 80%). Five studies were performed in Asia and 2 in Europe. In the subgroup analysis of studies performed in Asia, G-CSF was associated with a reduced risk of death (OR 0.15; 95% CI 0.08–0.28; p <0.001; heterogeneity: p = 0.5, I2 = 0%). In European studies, G-CSF tended to increase mortality compared with controls, although the difference was not significant (OR 1.89; 95% CI 0.90–3.98; p = 0.09; heterogeneity: p = 0.8, I2 = 0%). In Asian studies, occurrence of infection was less frequent in G-CSF patients than in controls (OR 0.12; 95% CI 0.06–0.23; p <0.001; heterogeneity: p = 0.7, I2 = 0%), whilst in European studies, this occurrence was not statistically different (OR 0.92; 95% CI 0.50–1.68; p = 0.78; heterogeneity: p = 0.5, I2 = 0%). In sensitivity analyses, excluding studies that included patients with acute-on-chronic liver failure (ACLF) other than AH, patients with less severe AH, or patients with non-response to corticosteroids, results were similar to those of overall analyses, both for mortality and occurrence of infection.
Granulocyte colony-stimulating factor therapy may improve the prognosis of patients with severe AH. However, owing to the high heterogeneity observed in the overall analysis caused by conflicting results between the Asian and European studies, G-CSF cannot currently be recommended for AH, particularly in Europe. Whether these differences can be explained by ethnic differences or disparities in patient selection and disease severity remains unclear.
The main finding of this meta-analysis is that the use of granulocyte colony-stimulating factor (G-CSF) is associated with a mortality reduction of more than 70% at 3 months amongst patients with alcoholic hepatitis (AH) compared with controls who did not receive this therapy. However, owing to the high heterogeneity observed in the overall analysis caused by conflicting results between the Asian and European studies, G-CSF cannot currently be recommended for patients with AH, particularly in Europe. Whether these differences can be explained by ethnic differences or disparities in patient selection and disease severity remains unclear.
[Display omitted]
•This meta-analysis reports pooled data from 7 studies on the use of G-CSF in patients with alcoholic hepatitis.•The favourable effect of G-CSF was only encountered in Asian not European studies.•Additional data are needed to clarify the usefulness of G-CSF in severe alcoholic hepatitis, particularly in Europe.</description><identifier>ISSN: 2589-5559</identifier><identifier>EISSN: 2589-5559</identifier><identifier>DOI: 10.1016/j.jhepr.2020.100139</identifier><identifier>PMID: 32775975</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Alcoholic hepatitis ; Infection ; Liver regeneration</subject><ispartof>JHEP reports, 2020-10, Vol.2 (5), p.100139-100139, Article 100139</ispartof><rights>2020 The Author(s)</rights><rights>2020 The Author(s).</rights><rights>2020 The Author(s) 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c525t-b1196615427aac47a616251a37607edd8e7434e52406abd8b79d516a86b64e683</citedby><cites>FETCH-LOGICAL-c525t-b1196615427aac47a616251a37607edd8e7434e52406abd8b79d516a86b64e683</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7396826/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S2589555920300732$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,3536,27901,27902,45756,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32775975$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Marot, Astrid</creatorcontrib><creatorcontrib>Singal, Ashwani K.</creatorcontrib><creatorcontrib>Moreno, Christophe</creatorcontrib><creatorcontrib>Deltenre, Pierre</creatorcontrib><title>Granulocyte colony-stimulating factor for alcoholic hepatitis: A systematic review and meta-analysis of randomised controlled trials</title><title>JHEP reports</title><addtitle>JHEP Rep</addtitle><description>Granulocyte colony-stimulating factor (G-CSF) treatment has been proposed as a therapeutic option for patients with severe alcoholic hepatitis (AH). The aim of this study was to synthesise available evidence on the efficacy of G-CSF in AH.
This is a meta-analysis of randomised controlled trials evaluating the risk of death at 90 days and the risk of infection.
Seven studies were included. Of a total of 396 patients, 336 had AH, 197 patients were treated with G-CSF, and 199 received placebo or pentoxifylline. In overall meta-analysis, G-CSF therapy was associated with a reduced risk of death at 90 days (odds ratio [OR] 0.28; 95% CI 0.09–0.88; p = 0.03). There was high heterogeneity between studies (p <0.001; I2 = 80%). Five studies were performed in Asia and 2 in Europe. In the subgroup analysis of studies performed in Asia, G-CSF was associated with a reduced risk of death (OR 0.15; 95% CI 0.08–0.28; p <0.001; heterogeneity: p = 0.5, I2 = 0%). In European studies, G-CSF tended to increase mortality compared with controls, although the difference was not significant (OR 1.89; 95% CI 0.90–3.98; p = 0.09; heterogeneity: p = 0.8, I2 = 0%). In Asian studies, occurrence of infection was less frequent in G-CSF patients than in controls (OR 0.12; 95% CI 0.06–0.23; p <0.001; heterogeneity: p = 0.7, I2 = 0%), whilst in European studies, this occurrence was not statistically different (OR 0.92; 95% CI 0.50–1.68; p = 0.78; heterogeneity: p = 0.5, I2 = 0%). In sensitivity analyses, excluding studies that included patients with acute-on-chronic liver failure (ACLF) other than AH, patients with less severe AH, or patients with non-response to corticosteroids, results were similar to those of overall analyses, both for mortality and occurrence of infection.
Granulocyte colony-stimulating factor therapy may improve the prognosis of patients with severe AH. However, owing to the high heterogeneity observed in the overall analysis caused by conflicting results between the Asian and European studies, G-CSF cannot currently be recommended for AH, particularly in Europe. Whether these differences can be explained by ethnic differences or disparities in patient selection and disease severity remains unclear.
The main finding of this meta-analysis is that the use of granulocyte colony-stimulating factor (G-CSF) is associated with a mortality reduction of more than 70% at 3 months amongst patients with alcoholic hepatitis (AH) compared with controls who did not receive this therapy. However, owing to the high heterogeneity observed in the overall analysis caused by conflicting results between the Asian and European studies, G-CSF cannot currently be recommended for patients with AH, particularly in Europe. Whether these differences can be explained by ethnic differences or disparities in patient selection and disease severity remains unclear.
[Display omitted]
•This meta-analysis reports pooled data from 7 studies on the use of G-CSF in patients with alcoholic hepatitis.•The favourable effect of G-CSF was only encountered in Asian not European studies.•Additional data are needed to clarify the usefulness of G-CSF in severe alcoholic hepatitis, particularly in Europe.</description><subject>Alcoholic hepatitis</subject><subject>Infection</subject><subject>Liver regeneration</subject><issn>2589-5559</issn><issn>2589-5559</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNp9UktuFDEQbSEQiUJOgIR6yaYH2-1PGwmkKIIQKRIbWFseu3rGI3d7sD1BcwDuwVk4GZWZECUbFlaVql695_o0zWtKFpRQ-W6z2KxhmxeMsLsIob1-1pwyMehOCKGfP_JPmvNSNoQQpjTH2pfNSc-UElqJ0-bXVbbzLia3r9C6FNO870oN0y7aGuZVO1pXU25HfDa6tE4xuBaVMVtDed9e_Pld9qXChAHXZrgN8LO1s28nqLazs437EkqbxhZ1fJpCAY86c80pRnRrDjaWV82LEQ2c39uz5vvnT98uv3Q3X6-uLy9uOieYqN2SUi0lFZwpax1XVlLJBLW9kkSB9wMo3nMQjBNpl35YKu0FlXaQS8lBDv1Zc33k9cluzDaHyea9STaYQyDllbEZG4lgOHFOe-KAS8pRTaOm7Mk4AHEj6B65Ph65trvlBN4B9mTjE9KnmTmszSrdGtVrOTCJBG_vCXL6sYNSDU7HQYx2hrQrhvGeDSh-gPZHqMuplAzjgwwl5u4ezMYc7sHc3YM53gNWvXn8w4eaf9tHwIcjAHDmuLlsigswO_Ahg6s4lPBfgb_Pt8vv</recordid><startdate>20201001</startdate><enddate>20201001</enddate><creator>Marot, Astrid</creator><creator>Singal, Ashwani K.</creator><creator>Moreno, Christophe</creator><creator>Deltenre, Pierre</creator><general>Elsevier B.V</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20201001</creationdate><title>Granulocyte colony-stimulating factor for alcoholic hepatitis: A systematic review and meta-analysis of randomised controlled trials</title><author>Marot, Astrid ; Singal, Ashwani K. ; Moreno, Christophe ; Deltenre, Pierre</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c525t-b1196615427aac47a616251a37607edd8e7434e52406abd8b79d516a86b64e683</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Alcoholic hepatitis</topic><topic>Infection</topic><topic>Liver regeneration</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Marot, Astrid</creatorcontrib><creatorcontrib>Singal, Ashwani K.</creatorcontrib><creatorcontrib>Moreno, Christophe</creatorcontrib><creatorcontrib>Deltenre, Pierre</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>JHEP reports</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Marot, Astrid</au><au>Singal, Ashwani K.</au><au>Moreno, Christophe</au><au>Deltenre, Pierre</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Granulocyte colony-stimulating factor for alcoholic hepatitis: A systematic review and meta-analysis of randomised controlled trials</atitle><jtitle>JHEP reports</jtitle><addtitle>JHEP Rep</addtitle><date>2020-10-01</date><risdate>2020</risdate><volume>2</volume><issue>5</issue><spage>100139</spage><epage>100139</epage><pages>100139-100139</pages><artnum>100139</artnum><issn>2589-5559</issn><eissn>2589-5559</eissn><abstract>Granulocyte colony-stimulating factor (G-CSF) treatment has been proposed as a therapeutic option for patients with severe alcoholic hepatitis (AH). The aim of this study was to synthesise available evidence on the efficacy of G-CSF in AH.
This is a meta-analysis of randomised controlled trials evaluating the risk of death at 90 days and the risk of infection.
Seven studies were included. Of a total of 396 patients, 336 had AH, 197 patients were treated with G-CSF, and 199 received placebo or pentoxifylline. In overall meta-analysis, G-CSF therapy was associated with a reduced risk of death at 90 days (odds ratio [OR] 0.28; 95% CI 0.09–0.88; p = 0.03). There was high heterogeneity between studies (p <0.001; I2 = 80%). Five studies were performed in Asia and 2 in Europe. In the subgroup analysis of studies performed in Asia, G-CSF was associated with a reduced risk of death (OR 0.15; 95% CI 0.08–0.28; p <0.001; heterogeneity: p = 0.5, I2 = 0%). In European studies, G-CSF tended to increase mortality compared with controls, although the difference was not significant (OR 1.89; 95% CI 0.90–3.98; p = 0.09; heterogeneity: p = 0.8, I2 = 0%). In Asian studies, occurrence of infection was less frequent in G-CSF patients than in controls (OR 0.12; 95% CI 0.06–0.23; p <0.001; heterogeneity: p = 0.7, I2 = 0%), whilst in European studies, this occurrence was not statistically different (OR 0.92; 95% CI 0.50–1.68; p = 0.78; heterogeneity: p = 0.5, I2 = 0%). In sensitivity analyses, excluding studies that included patients with acute-on-chronic liver failure (ACLF) other than AH, patients with less severe AH, or patients with non-response to corticosteroids, results were similar to those of overall analyses, both for mortality and occurrence of infection.
Granulocyte colony-stimulating factor therapy may improve the prognosis of patients with severe AH. However, owing to the high heterogeneity observed in the overall analysis caused by conflicting results between the Asian and European studies, G-CSF cannot currently be recommended for AH, particularly in Europe. Whether these differences can be explained by ethnic differences or disparities in patient selection and disease severity remains unclear.
The main finding of this meta-analysis is that the use of granulocyte colony-stimulating factor (G-CSF) is associated with a mortality reduction of more than 70% at 3 months amongst patients with alcoholic hepatitis (AH) compared with controls who did not receive this therapy. However, owing to the high heterogeneity observed in the overall analysis caused by conflicting results between the Asian and European studies, G-CSF cannot currently be recommended for patients with AH, particularly in Europe. Whether these differences can be explained by ethnic differences or disparities in patient selection and disease severity remains unclear.
[Display omitted]
•This meta-analysis reports pooled data from 7 studies on the use of G-CSF in patients with alcoholic hepatitis.•The favourable effect of G-CSF was only encountered in Asian not European studies.•Additional data are needed to clarify the usefulness of G-CSF in severe alcoholic hepatitis, particularly in Europe.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>32775975</pmid><doi>10.1016/j.jhepr.2020.100139</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Alcoholic hepatitis Infection Liver regeneration |
| title | Granulocyte colony-stimulating factor for alcoholic hepatitis: A systematic review and meta-analysis of randomised controlled trials |
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