Abstract
BACKGROUND: Hyperthyroidism, a common condition seen by physicians, is predominantly treated with antithyroid drugs. Agranulocytosis, a potentially fatal complication, is their most serious side effect. Conflicting studies are present between the risks and benefits of the use of exogenous granulocyte colony-stimulating factor (G-CSF) in its treatment, since its pathogenesis has not been established. The objective of this study is to determine the benefit of G-CSF in antithyroid drug-induced (ATD) agranulocytosis, through a meta-analysis.
Methods: Studies were included after extensive literature search in five electronic databases; all met the inclusion and exclusion criteria, and were critically appraised. The primary outcome was days to hematologic recovery, defined as neutrophilic rise to >0.5 x 109/L. Data were treated as continuous data, obtaining the standard mean difference through a Forrest Plot using the Review Manager 5.3 application.
Results: Five of the studies were non-concurrent cohort, while one was a randomized clinical trial. The duration of the studies was from 1970s to 2014. Age range of the population was from 8 to 87 years old, with more females. G-CSF dose ranged from 75 to 300ug/day, injected subcutaneously or intramuscularly. Primary outcome measured common to all the studies included hematologic recovery. Five of the six studies showed shorter number of days to hematologic recovery for the treatment group compared to the control group (with a standardized mean difference of 1 day, confidence interval (CI) of 0.45 to 1.54).
Conclusion: Exogenous G-CSF administration in ATD agranulocytosis contributed to faster hematologic recovery in terms of days, shortening recovery by a mean of 1 day.
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Serum Concentrations of Granulocyte Colony-Stimulating Factor (G-CSF) in Antithyroid Drug-Induced Agranulocytosis
