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

Content Provider	Europe PMC
Author	Cornes, Paul Gascon, Pere Chan, Stephen Hameed, Khalid Mitchell, Catherine R. Field, Polly Latymer, Mark Arantes, Luiz H.
Abstract	IntroductionShort- 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.MethodsMedline®/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.ResultsThe 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  < 0.05), and chemotherapy dose delays (overall RR = 0.68, P  = 0.020).ConclusionsOverall, the weight of evidence from RCTs indicates little difference in efficacy between the short- and long-acting G-CSFs if dosed according to recommended guidelines. There is some evidence for greater efficacy for long-acting G-CSFs in non-RCTs, which may be a result of under-dosing of short-acting G-CSFs in general practice in real-world usage.FundingHospira Inc, which was acquired by Pfizer Inc in September 2015, and Pfizer Inc.Electronic supplementary materialThe online version of this article (10.1007/s12325-018-0798-6) contains supplementary material, which is available to authorized users.
ISSN	0741238X
Journal	Advances in Therapy
Volume Number	35
PubMed Central reference number	PMC6223993
Issue Number	11
PubMed reference number	30298233
e-ISSN	18658652
DOI	10.1007/s12325-018-0798-6
Language	English
Publisher	Springer Healthcare
Publisher Date	2018-10-08
Publisher Place	Cheshire
Access Restriction	Open
Rights License	This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. © The Author(s) 2018, corrected publication October/2018
Subject Keyword	Chemotherapy Chemotherapy-induced febrile neutropenia Filgrastim Granulocyte colony-stimulating factor Neutropenia Oncology
Content Type	Text
Resource Type	Article
Subject	Pharmacology (medical)