METHODS: Based on the Minds Handbook for Clinical Practice Guideline Development, we searched the PubMed, Ichushi-Web, and Cochrane Library databases for literature published from January 1990 to December 2019. The inclusion criteria included studies among the adult population using pegfilgrastim. The search strategy focused on timing-related keywords. Two reviewers independently extracted and assessed the data.
RESULTS: Among 300 initial search results, only four articles met the inclusion criteria. A meta-analysis for febrile neutropenia incidence suggested a potential higher incidence when pegylated G-CSF was administered on Days 3-5 than on Day 2 (odds ratio: 1.27, 95% CI 0.66-2.46, p = 0.47), with a moderate certainty of evidence. No significant difference in overall survival or mortality due to infections was observed. The trend of severe adverse events was lower on Days 3-5, without statistical significance (odds ratio: 0.72, 95% CI 0.14-3.67, p = 0.69) and with a moderate certainty of evidence. Data on pain were inconclusive.
CONCLUSIONS: Both Day 2 and Days 3-5 were weakly recommended for pegylated G-CSF administration post-chemotherapy in patients with cancer. The limited evidence highlights the need for further research to refine recommendations.
方法:基于《临床实践指南开发思想手册》,我们搜索了PubMed,Ichushi-Web,和Cochrane图书馆数据库,用于1990年1月至2019年12月出版的文献。纳入标准包括使用pegfilgrastim在成年人群中进行的研究。搜索策略侧重于与时间相关的关键字。两名审阅者独立地提取并评估数据。
结果:在300个初始搜索结果中,只有四篇文章符合纳入标准。对发热性中性粒细胞减少症发生率的荟萃分析表明,在第3-5天给予聚乙二醇化G-CSF的发生率可能高于第2天(比值比:1.27,95%CI0.66-2.46,p=0.47)。具有适度的证据确定性。没有观察到由于感染引起的总生存率或死亡率的显著差异。在第3-5天,严重不良事件的趋势较低,无统计学意义(比值比:0.72,95%CI0.14-3.67,p=0.69),并且证据具有中等确定性。关于疼痛的数据尚无定论。
结论:第2天和第3-5天都弱推荐在癌症患者化疗后给予聚乙二醇化G-CSF。有限的证据强调需要进一步研究以完善建议。