High-dose acetylcysteine in idiopathic pulmonary fibrosis.
By M. Demedts, J. Behr, R. Buhl, U. Costabel, R. Dekhuijzen, H. Jansen, W. Macnee, M. Thomeer, B. Wallaert, F. Laurent and 13 more. New England Journal of Medicine, 2005
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BACKGROUND Idiopathic pulmonary fibrosis is a chronic progressive disorder with a poor prognosis. METHODS We conducted a double-blind, randomized, placebo-controlled multicenter study that assessed the effectiveness over one year of a high oral dose of acetylcysteine (600 mg three times daily) added to standard therapy with prednisone plus azathioprine. The primary end points were changes between baseline and month 12 in vital capacity and in single-breath carbon monoxide diffusing capacity (DL(CO)). RESULTS A total of 182 patients were randomly assigned to treatment (92 to acetylcysteine and 90 to placebo). Of these patients, 155 (80 assigned to acetylcysteine and 75 to placebo) had usual interstitial pneumonia, as confirmed by high-resolution computed tomography and histologic findings reviewed by expert committees, and did not withdraw consent before the start of treatment. Fifty-seven of the 80 patients taking acetylcysteine (71 percent) and 51 of the 75 patients taking placebo (68 percent) completed one year of treatment. Acetylcysteine slowed the deterioration of vital capacity and DL(CO): at 12 months, the absolute differences in the change from baseline between patients taking acetylcysteine and those taking placebo were 0.18 liter (95 percent confidence interval, 0.03 to 0.32), or a relative difference of 9 percent, for vital capacity (P=0.02), and 0.75 mmol per minute per kilopascal (95 percent confidence interval, 0.27 to 1.23), or 24 percent, for DL(CO) (P=0.003). Mortality during the study was 9 percent among patients taking acetylcysteine and 11 percent among those taking placebo (P=0.69). There were no significant differences in the type or severity of adverse events between patients taking acetylcysteine and those taking placebo, except for a significantly lower rate of myelotoxic effects in the group taking acetylcysteine (P=0.03). CONCLUSIONS Therapy with acetylcysteine at a dose of 600 mg three times daily, added to prednisone and azathioprine, preserves vital capacity and DL(CO) in patients with idiopathic pulmonary fibrosis better than does standard therapy alone.
Subfields: Molecular Biology, Pulmonary and Respiratory Medicine
View Paper: https://www.semanticscholar.org/paper/4f283161f0dfa3fa42f055394e8c06e9f1baf456
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Citations in the corpus
- Health effects of quercetin: from antioxidant to nutraceutical. (2008, background): “, 2006), pulmonary fibrosis (Behr et al., 1997; Demedts et al., 2005), diabetes (Hofmann, 1999) and cancer (Bairati et al.”
- The bleomycin animal model: a useful tool to investigate treatment options for idiopathic pulmonary fibrosis? (2008, neutral): “Those that appear to have a major effect include: Antioxidants (Ambroxol (Pozzi et al., 1989; Pozzi et al., 1987), Niacin (A. Nagai et al., 1994; O'Neill & Giri, 1994; Q. J. Wang, Giri, Hyde, Nakashima, & Javadi, 1990), Taurin (Blaisdell & Giri, 1995; Giri & Wang, 1992; Gurujeyalakshmi, Hollinger, &”
- An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline: Treatment of Idiopathic Pulmonary Fibrosis. An Update of the 2011 Clinical Practice Guideline. (2015, background): “The 2011 guideline included one RCT that compared N-acetylcysteine versus placebo in patients receiving prednisone and azathioprine (22).”
- Interstitial lung disease guideline (2008, methodology): “This has led to an international randomised double-blind study to assess the effects of NAC in patients in whom a confident or probable diagnosis of IPF was made either on clinicoradiological criteria (82 patients) or clinicoradiological criteria and a lung biopsy (73 patients).(9) All 155 patients ”
- Integrating mechanisms of pulmonary fibrosis (2011, background): “T h e Jo u rn al o f E xp er im en ta l M ed ic in e 1340 Mechanisms of pulmonary fibrosis | Wynn in IPF (Demedts et al., 2005).”