Efficacy and safety profile of mucolytic/antioxidant agents in chronic obstructive pulmonary disease: a comparative analysis across erdosteine, carbocysteine, and N-acetylcysteine.
Acetylcysteine
/ adverse effects
Antioxidants
/ adverse effects
Carbocysteine
/ adverse effects
Expectorants
/ adverse effects
Humans
Pulmonary Disease, Chronic Obstructive
/ diagnosis
Randomized Controlled Trials as Topic
/ methods
Thioglycolates
/ adverse effects
Thiophenes
/ adverse effects
Treatment Outcome
COPD
Carbocysteine
Erdosteine
Meta-analysis
N-acetylcysteine
Journal
Respiratory research
ISSN: 1465-993X
Titre abrégé: Respir Res
Pays: England
ID NLM: 101090633
Informations de publication
Date de publication:
27 May 2019
27 May 2019
Historique:
received:
16
04
2019
accepted:
20
05
2019
entrez:
29
5
2019
pubmed:
28
5
2019
medline:
24
12
2019
Statut:
epublish
Résumé
To date there are no head-to-head studies comparing different mucolytic/antioxidant agents. Considering the inconsistent evidence resulting from the pivotal studies on mucolytic/antioxidant agents tested in chronic obstructive pulmonary disease (COPD), and the recent publication of Reducing Exacerbations and Symptoms by Treatment with ORal Erdosteine in COPD (RESTORE) study, we have performed a meta-analysis to compare the efficacy and safety of erdosteine 600 mg/day, carbocysteine 1500 mg/day, and N-acetylcysteine (NAC) 1200 mg/day in COPD. A pairwise and network meta-analyses were performed to assess the efficacy of erdosteine, carbocysteine, and NAC on acute exacerbation of COPD (AECOPD), duration of AECOPD, and hospitalization. The frequency of adverse events (AEs) was also investigated. Data obtained from 2753 COPD patients were extracted from 7 RCTs published between 2004 and 2017. In the pairwise meta-analysis mucolytic/antioxidant agents significantly reduced the risk of AECOPD (RR 0.74 95%CI 0.68-0.80). The network meta-analysis provided the following rank of effectiveness: erdosteine>carbocysteine>NAC. Only erdosteine reduced the risk of experiencing at least one AECOPD (P < 0.01) and the risk of hospitalization due to AECOPD (P < 0.05). Erdosteine and NAC both significantly reduced the duration of AECOPD (P < 0.01). The AEs induced by erdosteine, carbocysteine, and NAC were mild in severity and generally well tolerated. The quality of evidence of this quantitative synthesis is moderate. The overall efficacy/safety profile of erdosteine is superior to that of both carbocysteine and NAC. Future head-to-head studies performed on the same COPD populations are needed to definitely confirm the results of this meta-analysis. CRD42016053762 .
Sections du résumé
BACKGROUND
BACKGROUND
To date there are no head-to-head studies comparing different mucolytic/antioxidant agents. Considering the inconsistent evidence resulting from the pivotal studies on mucolytic/antioxidant agents tested in chronic obstructive pulmonary disease (COPD), and the recent publication of Reducing Exacerbations and Symptoms by Treatment with ORal Erdosteine in COPD (RESTORE) study, we have performed a meta-analysis to compare the efficacy and safety of erdosteine 600 mg/day, carbocysteine 1500 mg/day, and N-acetylcysteine (NAC) 1200 mg/day in COPD.
METHODS
METHODS
A pairwise and network meta-analyses were performed to assess the efficacy of erdosteine, carbocysteine, and NAC on acute exacerbation of COPD (AECOPD), duration of AECOPD, and hospitalization. The frequency of adverse events (AEs) was also investigated.
RESULTS
RESULTS
Data obtained from 2753 COPD patients were extracted from 7 RCTs published between 2004 and 2017. In the pairwise meta-analysis mucolytic/antioxidant agents significantly reduced the risk of AECOPD (RR 0.74 95%CI 0.68-0.80). The network meta-analysis provided the following rank of effectiveness: erdosteine>carbocysteine>NAC. Only erdosteine reduced the risk of experiencing at least one AECOPD (P < 0.01) and the risk of hospitalization due to AECOPD (P < 0.05). Erdosteine and NAC both significantly reduced the duration of AECOPD (P < 0.01). The AEs induced by erdosteine, carbocysteine, and NAC were mild in severity and generally well tolerated. The quality of evidence of this quantitative synthesis is moderate.
CONCLUSIONS
CONCLUSIONS
The overall efficacy/safety profile of erdosteine is superior to that of both carbocysteine and NAC. Future head-to-head studies performed on the same COPD populations are needed to definitely confirm the results of this meta-analysis.
TRIAL REGISTRATION
BACKGROUND
CRD42016053762 .
Identifiants
pubmed: 31133026
doi: 10.1186/s12931-019-1078-y
pii: 10.1186/s12931-019-1078-y
pmc: PMC6537173
doi:
Substances chimiques
Antioxidants
0
Expectorants
0
Thioglycolates
0
Thiophenes
0
Carbocysteine
740J2QX53R
erdosteine
76J0853EKA
Acetylcysteine
WYQ7N0BPYC
Types de publication
Comparative Study
Journal Article
Meta-Analysis
Langues
eng
Sous-ensembles de citation
IM
Pagination
104Subventions
Organisme : Edmond Pharma Srl
ID : NA
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