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Published on: December 18, 2010
Granulocyte colony-stimulating factor improves survival of patients with decompensated cirrhosis: a
Ritesh Prajapati1, Anil Arora, Praveen Sharma
1Institute of Liver, Gastroenterology, and Panceaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India.
Insights
Granulocyte colony-stimulating factor (GCSF) therapy significantly improved survival and clinical outcomes in patients with decompensated cirrhosis. This treatment may help stabilize patients awaiting liver transplantation.
Area of Science:
- Hepatology
- Clinical Medicine
- Pharmacology
Background:
- Decompensated cirrhosis necessitates liver transplantation, but transplant waiting lists lead to mortality.
- Granulocyte colony-stimulating factor (GCSF) shows potential in managing advanced liver disease.
- This study investigates GCSF efficacy in patients with decompensated cirrhosis.
Purpose of the Study:
- To evaluate the efficacy of GCSF in improving survival and clinical outcomes for patients with decompensated cirrhosis.
- To assess the safety and impact of GCSF therapy on patients awaiting liver transplantation.
Main Methods:
- An open-labeled randomized-controlled trial was conducted.
- Patients received either GCSF plus standard medical therapy (SMT) or SMT alone for 6 months.
- Outcomes, including survival and Child-Turcotte-Pugh score, were assessed.
Main Results:
- GCSF therapy was well-tolerated with no significant adverse effects.
- Cumulative survival at 6 months was significantly higher in the GCSF+SMT group (79%) compared to the SMT-alone group (68%; P=0.025).
- Improvement or stability in Child-Turcotte-Pugh score was observed in 66% of the GCSF+SMT group versus 51% in the SMT-alone group (P=0.021).
Conclusions:
- GCSF therapy enhances survival and clinical outcomes in patients with decompensated cirrhosis.
- GCSF may serve as a valuable intervention to prevent disease progression in patients awaiting liver transplantation.
- Further research is warranted to determine optimal GCSF dosing and its potential to reduce the need for liver transplantation.
Background:
Liver transplantation is the only curative option for patients with decompensated cirrhosis; however, many patients die while awaiting transplantation. Granulocyte colony-stimulating factor (GCSF) has shown promising results in improving outcomes in patients with advanced liver disease. We evaluated the efficacy of GCSF in patients with decompensated cirrhosis in an open-labeled randomized-controlled trial.
Methods:
Consecutive patients with decompensated cirrhosis were randomized to receive either GCSF 300 μg twice daily for 5 days plus standard medical therapy (SMT) (GCSF+SMT group) or SMT alone (SMT alone group). Outcomes were assessed at 6 months from randomization.
Results:
A total of 126 patients [median age: 53 (range: 31-76) years, 85% men] received GCSF+SMT and 127 patients received SMT alone. Baseline characteristics were similar in both the groups. The 5-day GCSF therapy did not lead to any significant adverse effects. At 6 months, in the GCSF+SMT group, 17 patients had died and nine were lost to follow-up, whereas in the SMT-alone group, 30 patients had died and 11 were lost to follow-up. By intention-to-treat analysis, cumulative survival was significantly higher in the GCSF+SMT group (79 vs. 68%; P=0.025). Also, significantly more patients (66%) showed improvement or stability in the Child-Turcotte-Pugh score at 6 months in the GCSF+SMT group compared with the SMT-alone group (51%, P=0.021).
Conclusion:
GCSF therapy improves survival and clinical outcome in patients with decompensated cirrhosis. It may be useful in patients awaiting transplantation to prevent worsening during the waiting period. Further studies are needed to explore whether repeated periodic GCSF courses can further increase the survival and decrease the need for liver transplantation.Clinical trial registered at https://clinicaltrials.gov vide NCT02642003.
