Department of Respiratory and Critical Care Medicine, Special Medical Center of Chinese People's Armed Police Forces, Tianjin, China.
Logistics University of Chinese People's Armed Police Forces, Tianjin, China.
BMC Pulm Med. 2020 May 7;20(1):128. doi: 10.1186/s12890-020-1121-2.
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.
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.
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.
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.
虽然抗纤维化药物可显著减缓特发性肺纤维化 (IPF) 患者的肺功能下降，但仍需要进一步治疗以阻止疾病进展。抗氧化疗法使用 N-乙酰半胱氨酸 (NAC) 被认为是一种潜在的附加治疗方法，在某些临床实践中可以与抗纤维化药物联合使用。然而，关于这种联合治疗的疗效、耐受性和安全性的数据仍然有限。我们进行了一项系统评价和荟萃分析，以评估与单独使用吡非尼酮相比，联合治疗的安全性、耐受性和疗效。
我们系统地回顾了所有已发表的关于联合使用吡非尼酮 (PFD) 和 NAC (PFD+NAC) 治疗 IPF 患者的研究。主要结局指标是肺功能测试 (PFT) 的下降以及出现副作用的 IPF 患者的比例。
荟萃分析纳入了 6 项研究，共计 319 例 IPF 患者。从治疗开始到第 24 周，PFD+NAC 组与单独使用 PFD 组在预计用力肺活量 (FVC%) 和预计一氧化碳弥散量 (DLco%) 方面无显著差异。两组的副作用和停药率也相似。
这项系统评价和荟萃分析表明，与单独使用 PFD 相比，联合使用 NAC 并未改变 PFD 在 IPF 患者中的疗效、安全性或耐受性。
