Efficacy, safety, and tolerability of combined pirfenidone and N-acetylcysteine therapy: a systematic review and meta-analysis
Abstract Background While antifibrotic drugs significantly decrease lung function decline in idiopathic pulmonary fibrosis (IPF), there is still an unmet need to halt disease progression. Antioxidative therapy with N-acetylcysteine (NAC) is considered a potential additional therapy that can be combi...
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doaj-c8b89c8ff8764bf68de881e74df2dcf72020-11-25T02:58:54ZengBMCBMC Pulmonary Medicine1471-24662020-05-012011910.1186/s12890-020-1121-2Efficacy, safety, and tolerability of combined pirfenidone and N-acetylcysteine therapy: a systematic review and meta-analysisHanyu Shi0Dawei Yin1Francesco Bonella2Michael Kreuter3Ute Oltmanns4Xuren Li5Shouchun Peng6Luqing Wei7Department of Respiratory and Critical Care Medicine, Special Medical Center of Chinese People’s Armed Police ForcesDepartment of Respiratory and Critical Care Medicine, Special Medical Center of Chinese People’s Armed Police ForcesDepartment of Pneumology, Ruhrlandklinik, Centre for Interstitial and Rare Lung Disease, University Hospital, University Duisburg-EssenCenter for Interstitial and Rare Lung Diseases, Thoraxklinik, University of HeidelbergCenter for Interstitial and Rare Lung Diseases, Thoraxklinik, University of HeidelbergDepartment of Respiratory and Critical Care Medicine, Special Medical Center of Chinese People’s Armed Police ForcesDepartment of Respiratory and Critical Care Medicine, Special Medical Center of Chinese People’s Armed Police ForcesDepartment of Respiratory and Critical Care Medicine, Special Medical Center of Chinese People’s Armed Police ForcesAbstract Background While antifibrotic drugs significantly decrease lung function decline in idiopathic pulmonary fibrosis (IPF), there is still an unmet need to halt disease progression. Antioxidative therapy with N-acetylcysteine (NAC) is considered a potential additional therapy that can be combined with antifibrotics in some patients in clinical practice. However, data on the efficacy, tolerability, and safety of this combination are scarce. We performed a systematic review and meta-analysis to appraise the safety, tolerability, and efficacy of the combination compared to treatment with pirfenidone alone. Methods We systematically reviewed all the published studies with combined pirfenidone (PFD) and NAC (PFD + NAC) treatment in IPF patients. The primary outcomes referred to decline in pulmonary function tests (PFTs) and the rates of IPF patients with side effects. Results In the meta-analysis, 6 studies with 319 total IPF patients were included. The PFD + NAC group was comparable to the PFD alone group in terms of the predicted forced vital capacity (FVC%) and predicted diffusion capacity for carbon monoxide (DLco%) from treatment start to week 24. Side effects and treatment discontinuation rates were also comparable in both groups. Conclusion This systematic review and meta-analysis suggests that combination with NAC does not alter the efficacy, safety, or tolerability of PFD in comparison to PFD alone in IPF patients.http://link.springer.com/article/10.1186/s12890-020-1121-2Idiopathic pulmonary fibrosisPirfenidoneAcetylcysteineMeta-analysisSystematic review |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Hanyu Shi Dawei Yin Francesco Bonella Michael Kreuter Ute Oltmanns Xuren Li Shouchun Peng Luqing Wei |
spellingShingle |
Hanyu Shi Dawei Yin Francesco Bonella Michael Kreuter Ute Oltmanns Xuren Li Shouchun Peng Luqing Wei Efficacy, safety, and tolerability of combined pirfenidone and N-acetylcysteine therapy: a systematic review and meta-analysis BMC Pulmonary Medicine Idiopathic pulmonary fibrosis Pirfenidone Acetylcysteine Meta-analysis Systematic review |
author_facet |
Hanyu Shi Dawei Yin Francesco Bonella Michael Kreuter Ute Oltmanns Xuren Li Shouchun Peng Luqing Wei |
author_sort |
Hanyu Shi |
title |
Efficacy, safety, and tolerability of combined pirfenidone and N-acetylcysteine therapy: a systematic review and meta-analysis |
title_short |
Efficacy, safety, and tolerability of combined pirfenidone and N-acetylcysteine therapy: a systematic review and meta-analysis |
title_full |
Efficacy, safety, and tolerability of combined pirfenidone and N-acetylcysteine therapy: a systematic review and meta-analysis |
title_fullStr |
Efficacy, safety, and tolerability of combined pirfenidone and N-acetylcysteine therapy: a systematic review and meta-analysis |
title_full_unstemmed |
Efficacy, safety, and tolerability of combined pirfenidone and N-acetylcysteine therapy: a systematic review and meta-analysis |
title_sort |
efficacy, safety, and tolerability of combined pirfenidone and n-acetylcysteine therapy: a systematic review and meta-analysis |
publisher |
BMC |
series |
BMC Pulmonary Medicine |
issn |
1471-2466 |
publishDate |
2020-05-01 |
description |
Abstract Background While antifibrotic drugs significantly decrease lung function decline in idiopathic pulmonary fibrosis (IPF), there is still an unmet need to halt disease progression. Antioxidative therapy with N-acetylcysteine (NAC) is considered a potential additional therapy that can be combined with antifibrotics in some patients in clinical practice. However, data on the efficacy, tolerability, and safety of this combination are scarce. We performed a systematic review and meta-analysis to appraise the safety, tolerability, and efficacy of the combination compared to treatment with pirfenidone alone. Methods We systematically reviewed all the published studies with combined pirfenidone (PFD) and NAC (PFD + NAC) treatment in IPF patients. The primary outcomes referred to decline in pulmonary function tests (PFTs) and the rates of IPF patients with side effects. Results In the meta-analysis, 6 studies with 319 total IPF patients were included. The PFD + NAC group was comparable to the PFD alone group in terms of the predicted forced vital capacity (FVC%) and predicted diffusion capacity for carbon monoxide (DLco%) from treatment start to week 24. Side effects and treatment discontinuation rates were also comparable in both groups. Conclusion This systematic review and meta-analysis suggests that combination with NAC does not alter the efficacy, safety, or tolerability of PFD in comparison to PFD alone in IPF patients. |
topic |
Idiopathic pulmonary fibrosis Pirfenidone Acetylcysteine Meta-analysis Systematic review |
url |
http://link.springer.com/article/10.1186/s12890-020-1121-2 |
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