Systematic Review and Meta-analysis of Short- versus Long-Acting Granulocyte Colony-Stimulating Factors for Reduction of Chemotherapy-Induced Febrile Neutropenia

• Published in: Advances in therapy 2018-11, Vol.35 (11), p.1816-1829
• Main Authors: Cornes, Paul, Gascon, Pere, Chan, Stephen, Hameed, Khalid, Mitchell, Catherine R., Field, Polly, Latymer, Mark, Arantes, Luiz H.
• Format: Article
• Language: English
• Subjects: Cardiology; Endocrinology; Internal Medicine; Medicine; Medicine & Public Health; Oncology; Pharmacology/Toxicology; Review; Rheumatology
• ISSN: 0741-238X; 1865-8652
• DOI: 10.1007/s12325-018-0798-6

Introduction Short- and long-acting granulocyte-colony stimulating factors (G-CSFs) are approved for the reduction of febrile neutropenia. A systematic literature review was performed to identify randomized controlled trials (RCTs) and non-RCTs reporting the use of G-CSFs following chemotherapy treatment. Methods Medline ® /Medline in-process, Embase ® , and the Cochrane Library were searched for studies published between January 2003 and June 2016. A hand-search of relevant conference proceedings was conducted for meetings held between 2012 and 2016. Eligible studies were restricted to those reporting a direct, head-to-head comparison of short- versus long-acting G-CSFs for reduction of chemotherapy-induced febrile neutropenia. Risk-of-bias assessments were performed for full publications only. Results The search strategy yielded 4044 articles for electronic screening. Thirty-six publications were evaluated for the meta-analysis: 11 of 12 RCTs and 2 of 24 non-RCTs administered doses of the short-acting G-CSF filgrastim for ≥ 7 days. In RCT studies, there was no statistically significant difference in outcomes of interest between short- and long-acting G-CSFs. In non-RCTs, the overall risk was lower with long-acting G-CSF than with short-acting G-CSF for incidence of febrile neutropenia [overall relative risk (RR) = 0.67, P   = 0.023], hospitalizations (overall RR = 0.68, P