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

Adv Ther. 2018 Nov;35(11):1816-1829. doi: 10.1007/s12325-018-0798-6. Epub 2018 Oct 8.

Abstract

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 < 0.05), and chemotherapy dose delays (overall RR = 0.68, P = 0.020).

Conclusions: Overall, 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.

Funding: Hospira Inc, which was acquired by Pfizer Inc in September 2015, and Pfizer Inc.

Keywords: Chemotherapy; Chemotherapy-induced febrile neutropenia; Filgrastim; Granulocyte colony-stimulating factor; Neutropenia; Oncology.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Antineoplastic Agents / adverse effects*
  • Chemotherapy-Induced Febrile Neutropenia / drug therapy*
  • Chemotherapy-Induced Febrile Neutropenia / prevention & control*
  • Delayed-Action Preparations / pharmacology
  • Filgrastim / therapeutic use*
  • Granulocyte Colony-Stimulating Factor / therapeutic use*
  • Hematologic Agents / therapeutic use*
  • Humans
  • Neoplasms / drug therapy*

Substances

  • Antineoplastic Agents
  • Delayed-Action Preparations
  • Hematologic Agents
  • Granulocyte Colony-Stimulating Factor
  • Filgrastim

Associated data

  • figshare/10.6084/m9.figshare.7105239