INTRODUCTION: FN is a serious side effect of myelosuppressive chemotherapy associated with increased risk of hospitalization and other complications. Prophylactic G-CSFs can reduce FN risk, but no systematic reviews have focused on effectiveness of G-CSFs in real-world clinical practice.
OBJECTIVE: To perform a systematic review assessing comparative effectiveness of prophylaxis with long-acting (pegfilgrastim) and short-acting G-CSFs (filgrastim, lenograstim) in cancer patients in real-world clinical settings.
METHODS: Consistent with the Cochrane Collaboration Handbook (2009) and the Centre for Reviews and Dissemination’s Guidance for Undertaking Reviews in Health Care (2009), MEDLINE, Embase, BIOSIS, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library databases were searched for published articles (January 2002-June 2014), and congress databases (MASCC/ASCO/ESMO) and Google Scholar were searched for published abstracts (January 2012-August 2014).
RESULTS: Of 1,259 unique records identified, 18 met predefined inclusion criteria (15 retrospective and 3 prospective observational studies; multiple tumor types and chemotherapy regimens). The risks of FN and FNH were statistically compared in 13 studies (FN=7; FNH=6). For patients receiving prophylaxis with pegfilgrastim, FN risk was significantly lower in 3 studies, numerically lower in 3 studies, and numerically higher in 1 study, and FNH risk was significantly lower in all 6 studies compared with short-acting G-CSFs. Prophylaxis with pegfilgrastim versus short-acting G-CSFs was generally associated with fewer chemotherapy dose delays/reductions and less antibiotic use. Costs varied. Few FN-related deaths were reported.
CONCLUSIONS: These real-world findings suggest that risks of FN and FN-related complications were generally lower for prophylaxis with pegfilgrastim versus short-acting G-CSFs.
