Long-acting versus short-acting granulocyte colony-stimulating factors among cancer patients after chemotherapy in China

Abstract

Background: Granulocyte colony-stimulating factors (G-CSFs) include long-acting ones and short-acting ones. They have been mainly applied in Chinese clinical practice for years to prevent neutropenia. However, which type of G-CSF is more superior has not been conclusively determined. Methods: A systematic literature search was conducted using the PubMed, Embase, Cochrane Library, clinical trials.gov, China National Knowledge Infrastructure, and WAN FANG databases for related studies published till August 2021. Revman 5.3 software was used to assess the effectiveness and safety of these 2 types of G-CSFs in patients undergoing chemotherapy. Results: Ten studies involving 1916 patients were included in our meta-analysis to compare the effectiveness and safety of long-acting G-CSFs and short-acting G-CSFs. We found that the incidence of febrile neutropenia (relative risk [RR] 0.82; 95% confidence interval [CI] 0.57–1.17), the recovery time of the absolute neutrophil count (mean difference –0.23; 95% CI –0.49 to 0.03), and the fatigue rate (RR 0.82; 95% CI 0.62–1.07) were similar between the long- and the short-acting G-CSFs. However, the long-acting G-CSFs significantly decreased the incidence (RR 0.86; 95% CI 0.76–0.96) and shortened the duration (mean difference –0.19; 95% CI –0.38 to 0.00) of severe (grade ≥3) neutropenia, and decreased the rate of bone and/or muscle pain (RR 0.75; 95% CI 0.58–0.98). Conclusion: Primary prophylaxis with long-acting G-CSFs was more effective and safer than primary prophylaxis with short-acting G-CSFs in Chinese adults undergoing chemotherapy.

An observational, prospective, open label, multicenter study to evaluate the safety and effectiveness of pegfilgrastim as secondary prophylaxis to decrease the incidence of febrile neutropenia in Korean female patients with breast cancer

“…Bone pain is the most common AE caused by G-CSF and it can be induced by various mechanisms, including inflammatory processes, expansion of the bone marrow, stimulation of osteoclasts and osteoblasts, and afferent nerve stimulation [ 24 ]. According to a systematic review, long-acting G-CSF significantly decreased the rate of bone pain (RR 0.75; 95% CI 0.58–0.98) compared to short-acting G-CSF [ 25 ]. The bone pain events associated with pegfilgrastim were reported 20–45% in RCTs, while 59–71% in post-marketing surveys [ 24 ].…”

Balancing Benefits and Risks: A Literature Review on Hypersensitivity Reactions to Human G-CSF (Granulocyte Colony-Stimulating Factor)

“…Nowadays, besides filgrastim and lenograstim, eight major G-CSF drugs are known: long-acting filgrastim-pegfilgrastim, lipegfilgrastim, mecapefilgrastim [14], empegfilgrastim [15], S/L-G-CSF biosimilar-balugrastim [16], leridistim, pegleridistim [17], and pegteograstim [18].…”

Role of recombinant human granulocyte colony-stimulating factor in development of cancer-associated venous thromboembolism in lung cancer patients who undergo chemotherapy

“…Moreover, the present study further indicated that lung cancer patients who received long-acting rhG-CSF were more likely to develop VTE than those who received short-acting rhG-CSF. Owing to the better therapeutic efficacy of long-acting rhG-CSF in leukocyte boosting than shortacting rhG-CSF (34), long-acting rhG-CSF may correspondingly yield a higher risk of thrombosis due to its greater capacity for the elevation of leukocytes and longer drug maintenance effect.…”