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Pegfilgrastim safety and efficacy on the last chemotherapy day versus the next: systematic review and meta-analysis
  1. Xiaohua Ma,
  2. Jian Kang,
  3. Yufang Li and
  4. Xiaojian Zhang
  1. Department of pharmacy, The first affiliated hospital of zhengzhou university, Zhengzhou, Henan, China
  1. Correspondence to Professor Xiaojian Zhang, The first affiliated hospital of zhengzhou university, Zhengzhou, Henan, China; zdypharm{at}


Objectives To investigate the efficacy and safety of pegfilgrastim administered on the day of chemotherapy completion (same day) versus at least 1 day after chemotherapy (next day).

Methods We searched relevant literature published before April 2020 from the following databases: Embase, PubMed, Cochrane databases and Web of science.

Results One randomised controlled trial and 12 observational studies met all of the prespecified criteria for eligibility. The meta-analysis showed a significantly higher febrile neutropenia (FN) rate for the same-day group than that for the next-day arm in the first chemotherapy cycle (OR=2.56, 95% CI 1.19 to 5.48, p=0.02), and in all chemotherapy cycles (OR=1.54, 95% CI 1.29 to 1.84, p<0.00001). Results of subgroup analysis showed a higher FN rate in the same-day arm than in the next-day group for patients with breast cancer (OR=5.50, 95% CI 2.29 to 13.23, p=0.0001) and lymphoma (OR=1.53, 95% CI 1.00 to 2.34, p=0.05). The pooled analysis of studies on gynaecological malignancies showed that patients in the same-day group had a higher incidence of bone pain (OR=1.30, 95% CI 1.01 to 1.68, p=0.04) and a lower incidence of chemotherapy delay (OR=0.71, 95% CI 0.53 to 0.96, p=0.03) compared with the next-day group.

Conclusions Same-day administration of pegfilgrastim resulted in increased incidence of FN compared with the next-day schedule. This is especially true for patients with breast cancer or lymphoma. These results do not support same-day administration of pegfilgrastim .

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  • Correction notice This article has been updated since it was first published. The article type has been changed to Systematic review.

  • Contributors This systematic review was designed and conducted by XM and XZ. YL, JK and XM performed the literature search, screening and data extraction. XM and JK undertook the data analysis. XM wrote the study protocol and this manuscript. XM and XZ were responsible for the overall content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.