Efficacy and Safety of N-Acetylcysteine in Idiopathic Pulmonary Fibrosis:A Meta-Analysis
WANG Chun-bin1,2, ZHANG Xun-yan1,2, LI Peng-mei2, ZHANG Xiang-lin2*
1. Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; 2. Department of Pharmacy, China-Japan Friendship Hospital, Beijing 100029, China
Abstract��OBJECTIVE To investigate the efficacy and safety of N-acetylcysteine(NAC) in treatment of patients with idiopathic pulmonary fibrosis(IPF) and provide evidence for clinical medication. METHODS We electronically searched PubMed, The Cochrane Library, EM base, CNKI, Wan Fang Data and VIP database for all relevant studies about NAC in management of patients with IPF from the date of database establishment to September 2017. Two independent reviewers exact data and assess the quality of included studies. All statistical analyses were performed using RevMan V.5.3. RESULTS A total of nine studies were included for final Meta-analysis, involving 666 patients. Our Meta-analysis indicated that NAC group can significantly decrease the change in the forced vital capacity(FVC) [MD=0.14, 95%CI(-0.00, 0.28), P=0.05], percentage of predicted vital capacity(VC%) [MD=3.84, 95%CI(1.02, 6.66), P=0.008] and carbon monoxide diffusing capacity(DLco%) [MD=0.10, 95%CI(0.03, 0.17), P=0.006] when compared with control group, and there were no significant difference in the change of six minutes walking test distance [MD=17.58,95%CI(-4.23,39.38), P=0.008], rates of adverse events[OR=1.28, 95%CI(0.83,1.98), P=0.26], or death [OR=0.98, 95%CI(0.40,2.43), P=0.06] between NAC group and control group. A further subgroup analysis according to route of administration indicated that inhalation administration NAC group can significant decrease the change in FVC(P=0.04), whereas oral administration NAC group had no statistically difference in the change of FVC when compared with control group(P=0.48). Both inhalation and oral administration NAC group had no statistically difference in rates of adverse events or death rates when compared with control group(P<0.05). CONCLUSION Present evidence shows that NAC is well tolerated and can significantly decrease the decline in lung function but can not decrease rates of death. Besides, different routes of administration may affect the efficacy of NAC, inhalation administration seems better than oral administration.
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2018, Vol. 53 
