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Evidence summaries

Colony Stimulating Factors Including Erythropoietin (EPO), Granulocyte Colony Stimulating Factor (G-CSF) and Analogues for Stroke

Colony stimulating factors appear not to be effective in the treatment of recent stroke. There appears to be significant safety concerns regarding EPO therapy. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 11 studies involving 1275 participants. Most trials were small safety studies. The patients were randomized on erythropoietin (EPO) trials within 48 hours after the ischaemic stroke. In 3 trials (n = 782), EPO therapy was associated with a significant increase in death by the end of the trial (OR 1.98, 95% CI 1.19 to 3.3, p = 0.009) and a non-significant increase in serious adverse events. EPO significantly increased the red cell count with no effect on platelet or white cell count, or infarct volume. Eight small trials (n = 548) of granulocyte colony stimulating factor (G-CSF) were included. The patients were randomized on G-CSF within 30 days of ischaemic stroke, so all patients were not acute ischaermic patients. G-CSF was associated with a non-significant reduction in early impairment (MD -0.4, 95% CI -1.82 to 1.01, p = 0.58) but had no effect on functional outcome at the end of the trial. G-CSF significantly elevated the white cell count and the CD34+ cell count, but had no effect on infarct volume.

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions).

    References

    • Bath PM, Sprigg N, England T. Colony stimulating factors (including erythropoietin, granulocyte colony stimulating factor and analogues) for stroke. Cochrane Database Syst Rev 2013;6():CD005207. [PubMed].

Primary/Secondary Keywords