Meta-analysis of Pegfilgrastim over Filgrastim in the Treatment of Chemotherapy-induced Neutropenia

Introduction: Neutropenia is a major common complication in patients who are treated with myelosuppressive chemo- therapy. Prophylaxis with granulocyte colony-stimulating factors (G-CSFs) has been used to reduce the incidence, duration, and severity of chemotherapy-induced neutropenia (CIN). Methods: This study aimed to examine the efficacy and safety of pegfilgrastim compared with filgrastim in treating che-motherapy-induced febrile neutropenia. PubMed/MEDLINE, Cochrane Library, Scopus, Embase, and Web of science were searched until December 2015. The search was updated in January 2018. Also, the reference lists of included studies were screened for additional citations. The quality of studies was evaluated using the Cochrane risk of bias tools and the random effect model was applied for analyzing the result. Results: Eleven studies with 1,578 participants (799 in pegfilgrastim arm and 779 in filgrastim arm) fulfilled the inclusion criteria. The incidence of grade 4 neutropenia and febrile neutropenia, the duration of grade 4 neutropenia, and recovery of the absolute neutrophil count were slightly reduced in the pegfilgrastim group, though this difference was not statistically significant. For bone pain, despite the observed superiority in the pegfilgrastim group, there was no significant difference between the two drugs. Conclusion: The results of our review suggest that there is no overall treatment benefit for a median 10–14 days of filgrastim compared to a single dose of pegfilgrastim in the incidence of grade 4 neutropenia, incidence of febrile neutropenia, duration of grade 4 neutropenia, and recovery of absolute neutrophil count and bone pain in the treatment of CIN.