Granulocyte-Colony-Stimulating Factor Effectively Shortens Recovery Duration in Anti-Thyroid-Drug-Induced Agranulocytosis: A Systematic Review and Meta-Analysis

• Main Authors: Yonghui Wang, Xiaoying Li, Qian Yang, Wei Wang, Yanan Zhang, Jun Liu, Liang Zheng, Bingbing Zha
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2019-11-01
• Series: Frontiers in Endocrinology
• Subjects: agranulocytosis; ATD; G-CSF; hyperthyroidism; treatment
• Online Access: https://www.frontiersin.org/article/10.3389/fendo.2019.00789/full

Background and aim: Granulocyte-colony-stimulating factor (G-CSF) is highly beneficial as a general treatment for anti-thyroid drug (ATD)-induced agranulocytosis. This meta-analysis aimed to assess the clinical effects of G-CSF and non-G-CSF on recovery duration in patients with ATD-induced agranulocytosis by analyzing the overall clinical outcomes.Methods: The PubMed, Embase, Ovid, Cochrane, Google Scholar, China National Knowledge Infrastructure (CNKI) databases were searched for published studies from 1900 to 2018. No language restriction was implemented.Results: This meta-analysis included 10 published retrospective studies and one prospective study. Data were obtained from 11 trials (474 patients: 247 with G-CSF and 227 with non-G-CSF treatment). Compared with the non-G-CSF group, the G-CSF group presented shorter recovery duration [weighted mean difference (WMD) = −3.04 days, 95% confidence interval (95% CI): −4.38 to −1.69 (Z = 4.43 P = 0.000)]. However, the recovery duration varied across regions and recovery criteria. Asian patients achieved significant clinical outcomes [WMD = −3.16 days (95% CI: −4.58 to −1.74, P = 0.000)] compared with European and South American patients [WMD = −2.19 days (95% CI: −7.38 to 3.01, P = 0.409)]. Also, according to various recovery criteria, a duration of granulocyte count increase of more than 1.5 or 1.0 × 109/L [WMD = −3.50 days (95% CI: −4.82 to −2.18, P = 0.000)] revealed a better treatment effect.Conclusion: G-CSF can significantly shorten the recovery duration in patients with ATD-induced agranulocytosis.