Efficacy and safety of N‑acetylcysteine therapy for idiopathic pulmonary fibrosis: An updated systematic review and meta‑analysis

Fen,Fanchao; Zhang,Jiarui; Wang,Zhichao; Wu,Qi; Zhou,Xianmei

doi:10.3892/etm.2019.7579

Efficacy and safety of N‑acetylcysteine therapy for idiopathic pulmonary fibrosis: An updated systematic review and meta‑analysis

Authors:
- Fanchao Fen
- Jiarui Zhang
- Zhichao Wang
- Qi Wu
- Xianmei Zhou
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Affiliations: Department of Respiratory Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China, State Key Laboratory Cultivation Base for TCM Quality and Efficacy, School of Medicine and Life Science, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
Published online on: May 15, 2019 https://doi.org/10.3892/etm.2019.7579
Pages: 802-816
Copyright: © Fen et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Idiopathic pulmonary fibrosis (IPF) is a progressive and ultimately fatal lung disease with poor prognosis and limited treatment options. N‑acetylcysteine (NAC), an anti‑oxidant drug, has promising potential in the treatment of IPF. In the present systematic review and meta‑analysis, the efficacy and safety of NAC for IPF were investigated. The following databases were comprehensively searched for relevant studies published until August 2018: Pubmed, Embase, Cochrane library, Chinese National Knowledge Infrastructure, Wangfang Database, VIP and the Chinese Biology Medical Database. A total of 21 controlled trials assessing the efficacy and safety of NAC therapy for IPF were identified and primary outcomes [forced vital capacity (FVC), adverse side effects] and secondary outcomes [diffusing capacity for carbon monoxide (DLCO) and its percentage predicted value (DLCO%), vital capacity (VC), partial arterial oxygen pressure (PaO2), 6‑min walking distance test and mortality] were extracted for the meta‑analysis. The risk ratio and mean difference or standardized mean difference with 95% confidence interval were calculated using RevMan 5.3 software. Analysis of the pooled data revealed that, compared with control treatments (routine treatment or drugs other than anti‑oxidants), NAC therapy reduced the decline in lung function, as indicated by the FVC and DLCO, and slowed the progression of the disease, as indicated by the PaO2, while complications and mortality were similar. These results suggest good efficacy, tolerability and safety of the treatment. Furthermore, subgroup analysis revealed that combined therapy including NAC for IPF might be more effective than NAC monotherapy, while oral administration of NAC was safer than inhalation. In conclusion, the results of the present review and meta‑analysis provide important information that may serve as a guide regarding NAC therapy for IPF in clinical practice.

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