Chemotherapy remains to be one of the cornerstones of cancer management. Due to the inherent ability of chemotherapy to act on rapidly dividing cells, myelosuppression is one of the noted side effects. Febrile neutropenia (FN), an oncologic emergency, may be prevented with administration of granulocyte-colony stimulating factor (G-CSF) in patients who are at risk for neutropenia based on type and number of myelosuppressive chemotherapy agents used, the type of cancer and patient-related factors. Most common adverse events are injection site and bone pain. Recent studies showed promising results on prevention of G-CSF induced bone pain using histamine blockade.
A systematic search of Pubmed, Cochrane, Clinical trials databases and hand search were done to identify randomized controlled trials (RCTs) investigating the use of Loratadine for prevention of G-CSF bone pain. Studies were appraised using the Cochrane Collaboration tool. Using the random effects model, pooled Odds ratios (ORs) with 95% confidence intervals (CI), results were analyzed.
Two RCTs were included ( N=814). Patients in the Loratadine group reported lesser bone pain as compared to the control group, 57% and 60% respectively (OR 0.95, CI [0.81, 1.10). However, the result was not statistically significant (P=0.52).
Histamine blockade with Loratadine in the prevention of bone pain induced by G-CSF did not show statistically significant advantage over placebo or no prophylaxis.
The authors.
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