BackgroundTo 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 600mg/day, carbocysteine 1500mg/day, and N-acetylcysteine (NAC) 1200mg/day in COPD.MethodsA 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.ResultsData 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.ConclusionsThe 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 registrationCRD42016053762.

Rogliani, P., Matera, M.g., Page, C., Puxeddu, E., Cazzola, M., Calzetta, L. (2019). Efficacy and safety profile of mucolytic/antioxidant agents in chronic obstructive pulmonary disease: a comparative analysis across erdosteine, carbocysteine, and N-acetylcysteine. RESPIRATORY RESEARCH, 20(1) [10.1186/s12931-019-1078-y].

Efficacy and safety profile of mucolytic/antioxidant agents in chronic obstructive pulmonary disease: a comparative analysis across erdosteine, carbocysteine, and N-acetylcysteine

Rogliani P.
;
Puxeddu E.;Cazzola M.;Calzetta L.
2019-01-01

Abstract

BackgroundTo 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 600mg/day, carbocysteine 1500mg/day, and N-acetylcysteine (NAC) 1200mg/day in COPD.MethodsA 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.ResultsData 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.ConclusionsThe 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 registrationCRD42016053762.
2019
Pubblicato
Rilevanza internazionale
Articolo
Esperti anonimi
Settore MED/10 - MALATTIE DELL'APPARATO RESPIRATORIO
English
Con Impact Factor ISI
COPD; Carbocysteine; Erdosteine; Meta-analysis; N-acetylcysteine
Rogliani, P., Matera, M.g., Page, C., Puxeddu, E., Cazzola, M., Calzetta, L. (2019). Efficacy and safety profile of mucolytic/antioxidant agents in chronic obstructive pulmonary disease: a comparative analysis across erdosteine, carbocysteine, and N-acetylcysteine. RESPIRATORY RESEARCH, 20(1) [10.1186/s12931-019-1078-y].
Rogliani, P; Matera, Mg; Page, C; Puxeddu, E; Cazzola, M; Calzetta, L
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/217796
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