Granulocyte Colony Stimulating Factor and Its Combinations With Anti-inflammatory Therapies in Severe Alcoholic...

Granulocyte colony-stimulating factor (GCSF) has been used to treat severe alcohol-associated hepatitis (SAH) in different combinations and dosages with variable outcomes. We aimed to evaluate the efficacy of GCSF for the treatment of severe alcoholic hepatitis (AH).

We conducted a systematic review and meta-analysis of studies comparing GCSF versus standard medical therapy (SMT) to treat patients with severe AH.

Eight studies were selected after screening 875 studies with a total of 1241 participants enrolled including 376 female participants. Overall 90-day survival rates were 85.35% and 61.8% in GCSF and SMT groups, respectively. GCSF therapy was associated with a significant increase in 90-day survival, with an odds ratio (OR) of 3.61 (95% confidence interval [CI]: 2.6-5.00) and I² = 7.2%. The 28-day survival between the GCSF therapy and SMT groups were comparable (83.91% and 72.9%, respectively), with an OR of 1.9 (95% CI: 0.87-4.1) and I² = 43.2%. In patients who received anti-inflammatory therapies in combination with GCSF, overall survival was 83.89% and 81.35% in the combination group and 71.84% and 51.45% in the SMT group on days 28 and 90, respectively, with an overall pooled OR of 4.86 (95% CI: 1.63-14.46) at day 90 and 2.53 (95% CI, 1.07-6.03) on day 28 associated low heterogeneity (I² = 20.5% and 24.2%, respectively). The overall rate of infection on day 90 was 20.1% in the GCSF arm and 27.22% in the control arm, with pooled ORs of 0.36 (95% CI: 0.18-0.691). The overall variceal bleeding rates were 5.6% in the GCSF and 14.07% in the control group on day 90. GCSF therapy is associated with a decreased risk of variceal bleeding compared with controls, with an OR of 0.41 (95% CI: 0.25-0.67).

GCSF therapy is associated with higher survival and lower adverse events in SAH. Combining GCSF with anti-inflammatory therapies can further improve 28- and 90-day survival.