title: The impact of primary prophylaxis with granulocyte colony-stimulating factors on febrile neutropenia during chemotherapy: a systematic review and meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  The study aims to assess the relative efficacy of granulocyte colony-stimulating factor (G-CSF) products administered as primary prophylaxis (PP) to patients with cancer receiving myelosuppressive chemotherapy.
  
  
  METHODS
  A systematic literature review identified publications (January 1990 to September 2013) of randomized controlled trials evaluating PP with filgrastim, pegfilgrastim, lenograstim, or lipegfilgrastim in adults receiving myelosuppressive chemotherapy for solid tumors or non-Hodgkin lymphoma. Direct, indirect, and mixed-treatment comparison (MTC) were used to estimate the odds ratio and 95 % credible interval of febrile neutropenia (FN) during cycle 1 and all cycles of chemotherapy combined without adjusting for differences in relative dose intensity (RDI) between study treatment arms.
  
  
  RESULTS
  Twenty-seven publications representing 30 randomized controlled trials were included. Using MTC over all chemotherapy cycles, PP with filgrastim, pegfilgrastim, lenograstim, and lipegfilgrastim versus no G-CSF PP or placebo were associated with statistically significantly reduced FN risk. FN risk was also significantly reduced with pegfilgrastim PP versus filgrastim PP. Over all chemotherapy cycles, there was a numerical but statistically nonsignificant increase in the FN risk for lipegfilgrastim PP versus pegfilgrastim PP. Using MTC in cycle 1, PP with filgrastim, pegfilgrastim, and lipegfilgrastim versus no G-CSF PP or placebo were associated with statistically significantly reduced FN risk.
  
  
  CONCLUSIONS
  In this meta-analysis, using MTC without adjustment for RDI, PP with all G-CSFs evaluated reduced the FN risk in patients receiving myelosuppressive chemotherapy. Future studies are needed to assess the influence of RDI on FN outcomes and to eliminate potential bias between G-CSF arms receiving more intensive chemotherapy than control arms.
authors.affiliation: STATinMED Research, Inc., 1400 Preston Rd, Suite 400, Plano, TX, USA. lwang@statinmed.com.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.|STATinMED Research, Inc., Ann Arbor, MI, USA.
authors.forename: Onur
authors.initials: O
authors.lastname: Baser
authors.affiliation: Amgen Europe, Zug, Switzerland.
authors.forename: Lucie
authors.initials: L
authors.lastname: Kutikova
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Page
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Barron
mesh_terms: D000328:Adult; D064147:Febrile Neutropenia / Q000139:chemically induced / Q000517:prevention & control*; D005260:Female; D000069585:Filgrastim / Q000009:adverse effects / Q000627:therapeutic use*; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D000078224:Lenograstim; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D016017:Odds Ratio; D011092:Polyethylene Glycols; D011322:Primary Prevention; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; C455861:pegfilgrastim; D011092:Polyethylene Glycols; D000078224:Lenograstim; D000069585:Filgrastim
keywords: Febrile neutropenia; Filgrastim; G-CSF; Lipegfilgrastim; Meta-analysis; Pegfilgrastim
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