Clinical use of evidence-based medicine--clinical questions: Acetylcysteine, a new treatment for an old foe?
This is a small, good quality, randomized controlled trial that shows a modest slowing in the deterioration of VC and DLco with the addition of high dose N-acetylcysteine to standard therapy in IPF. Overall the study should be interpreted with caution given its high drop out rate, which may have biased the results towards a more dramatic slowing of the disease progression. There were no differences in dyspnea score or functional status. There was no increase in the adverse events in the N-acetylcysteine group and the medication is inexpensive. Given only modest effects of N-acetylcysteine on VC and DLco, no change in functional scores, and the flaws of the study we would hesitate to use N-acetylcysteine as standard therapy in all patients with IPF.
Bennett
Lindsey
L
Department of Medicine, University of Wisconsin School of Medicine and Public Health, USA.
Crouse
Robert
R
Feldstein
David
D
D000111:Acetylcysteine / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000975:Antioxidants / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D001379:Azathioprine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D017079:Exercise Tolerance / Q000187:drug effects; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D011653:Pulmonary Diffusing Capacity / Q000187:drug effects; D011658:Pulmonary Fibrosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D014797:Vital Capacity / Q000187:drug effects
D000893:Anti-Inflammatory Agents; D000975:Antioxidants; D007166:Immunosuppressive Agents; D001379:Azathioprine; D011241:Prednisone; D000111:Acetylcysteine