Background: The aim of this review and meta-analysis was to identify, assess, meta-analyze and summarize the comparative effectiveness and safety of
filgrastim in head-to-head trials with placebo/no treatment,
pegfilgrastim (and
biosimilar filgrastim to update advances in the field. Methods: The preferred reporting items for systematic reviews and meta-analyses
PRISMA statement were applied, and a random-effect model was used. Primary endpoints were the rate and duration of grade 3 or 4
neutropenia, and an incidence rate of
febrile neutropenia. Secondary endpoints were time to absolute neutrophil count ANC recovery, depth of ANC nadir (lowest ANC),
neutropenia-related hospitalization and other
neutropenia-related complications. For
filgrastim versus
biosimilar filgrastim comparison, the primary efficacy endpoint was the mean difference in duration of severe
neutropenia DSN. Results: A total of 56 studies were considered that included data from 13,058
cancer patients. The risk of
febrile neutropenia in
filgrastim versus placebo/no treatment was not statistically different. The risk ratio for
febrile neutropenia was 0.58, a 42% reduction in favor of
filgrastim. The most reported adverse event with FIL was bone
pain. For
pegfilgrastim versus
filgrastim, no statistically significant difference was noted. The risk ratio was 0.90 (95% CI 0.67 to 1.12). The overall difference in duration of severe
neutropenia between
filgrastim and
biosimilar filgrastim was not statistically significant. The risk ratio was 1.03 (95% CI 0.93 to 1.13). Conclusions:
Filgrastim was effective and safe in reducing
febrile neutropenia and related complications, compared to placebo/no treatment. No notable differences were found between
pegfilgrastim and
filgrastim in terms of efficacy and safety. However, a similar efficacy profile was observed with FIL and its
biosimilars.