Comparing the efficacy and safety of long and short acting drugs targeting Granulocyte Colony-stimulating Factor in cancer patients after chemotherapy: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Granulocyte Colony-Stimulating Factor (G-CSF) is widely targeted for the treatment of cancer patients after chemotherapy. However, the safety and efficacy comparisons of long (L-G-CSF) and short-acting (S-G-CSF) drugs targeting G-CSF are still lacking. Thus, herein, we attempted to address this issue by undertaking meta-analyses of existing studies using different drugs targeting G-CSF. Methods: The relevant studies were identified by searching Pubmed, EMBASE, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases. Febrile neutropenia (FN) was considered as the direct primary efficacy endpoint, while severe neutropenia (SN) and the duration of severe neutropenia (DSN) served as secondary efficacy endpoints. Bone pain (BP) was used as an indicator for safety analysis. All identified trials were assessed using the Cochrane Collaboration Tool and meta-analysis was performed using Review Manager 5.3 and STATA 15.0 software. Results: Our meta-analyses based on 20 randomized controlled trials (RCTs) revealed that L-G-CSF drugs including empegfilgrastim, L-G-CSF biosimilars, and pegfilgrastim were overall better in reducing FN incidence compared to S-G-CSF drugs like filgrastim and lenograstim (odds ratio [OR]=0.70, 95% confidence interval [CI]=0.54~0.92, p=0.01). Specifically, filgrastim resulted in higher FN risk than pegfilgrastim (OR=0.66, 95% CI=0.50~0.87, p=0.004). However, L-G-CSF and S-G-CSF drugs revealed no differences in terms of SN, DSN, and BP endpoints (SN: OR=0.92, 95% CI=0.78~1.09, p=0.33; DSN: RR=-0.04, 95% CI=0.17~0.09, p=0.53; BP: OR=0.87, 95% CI=0.67~1.14, p=0.31). Conclusion: Based on our analyses, L-G-CSF drugs in comparison to S-G-CSF drugs resulted in significantly lower FN incidence, but no difference in terms of the SN, DSN, and BP endpoints.