Efficacy of antioxidant in idiopathic pulmonary fibrosis

Kandhare, Amit D.; Mukherjee, Anwesha; Ghosh, Pinaki; Bodhankar, Subhash L.

Efficacy of antioxidant in idiopathic pulmonary fibrosis

dc.contributor.author	Kandhare, Amit D.
dc.contributor.author	Mukherjee, Anwesha
dc.contributor.author	Ghosh, Pinaki
dc.contributor.author	Bodhankar, Subhash L.
dc.date.accessioned	2017-03-20T10:04:08Z
dc.date.available	2017-03-20T10:04:08Z
dc.date.issued	2016-11-07
dc.description.abstract	Idiopathic pulmonary fibrosis (IPF) is a chronic oxido-inflammatory disorder of the lung. Oxidative stress is widely recognized as a central feature of IPF. Antioxidant therapy has been proposed as an effective treatment for IPF. An array of clinical trials describing the therapeutic impact of these drugs have been reporting albeit with conflicting evidence points. We performed a meta-analysis of trials in which efficacy of antioxidant therapy was compared with control in IPF. Systematic literature search was conducted in PubMed, EMBASE, the Cochrane Library, CPCI-S (Conference Proceedings Citation Index-Science), ICTRP (International Clinical Trials Registry Platform), and Google Scholar till June 2016 by two independent researchers. Various outcomes such as changes in pulmonary function tests (change in vital capacity [ΔVC], change in forced vital capacity [ΔFVC], change in percentage of predicted vital capacity [Δ%VC], and change in percentage of predicted carbon monoxide diffusing capacity [Δ%DLco]), changes in 6 minutes walking test distance (Δ6MWT), rates of adverse events, and rates of death, were included. All statistical analyses were performed using RevMan V.5.3.Twelve studies (n = 1062) were identified that used antioxidants (N-acetylcysteine and lecithinized superoxide dismutase) as a treatment for IPF. Overall, there was no association of antioxidant therapy with ΔFVC (SMD = 0.27, 95% CI:-0.07 to 0.61; P = 0.12), ΔFVC (%) (SMD = -0.10, 95% CI:-0.56 to 0.36; P = 0.66) and 6MWT (SMD = -0.04, 95% CI:-0.11 to 0.20; P = 0.59) in IPF patients. However, combined antioxidant therapy was found to be associated with %VC (SMD = 0.37, 95% CI: 0.09 to 0.64; P = 0.008) and Δ%DLco (SMD = 0.15, 95% CI: 0.00 to 0.29; P = 0.05) in IPF patients. Strong evidence was obtained that the antioxidants increased adverse effects adverse events (OR = 1.56, 95% CI: 0.75 to 3.24; P = 0.23) but it did not associate mortality (OR = 0.96, 95% CI: 0.44 to 2.11; P = 0.92). The use of significant clinical heterogeneity, low statistical power, high dropout rates, duration of follow-ups, and dosing regimens of antioxidant agents. Combined antioxidant therapy seems to be a safe and effective therapy for IPF patients which provides a more beneficial effect in terms of VC, and DLco rather than monotherapy. Further randomized controlled trials with homogeneous outcome measures are needed.	en
dc.identifier.doi	10.17179/excli2016-619
dc.identifier.issn	1611-2156
dc.identifier.uri	http://hdl.handle.net/2003/35872
dc.identifier.uri	http://dx.doi.org/10.17877/DE290R-17896
dc.language.iso	en
dc.relation.ispartofseries	EXCLI Journal;Vol. 15, 2016
dc.rights.uri	https://creativecommons.org/licenses/by/4.0/
dc.subject	antioxidant	en
dc.subject	meta-analysis	en
dc.subject	idiopathic pulmonary fibrosis	en
dc.subject	vital capacity	en
dc.subject	carbon monoxide diffusing capacity	en
dc.subject.ddc	610
dc.title	Efficacy of antioxidant in idiopathic pulmonary fibrosis	en
dc.title.alternative	a systematic review and meta-analysis	en
dc.type	Text
dc.type.publicationtype	article
dcterms.accessRights	open access
eldorado.dnb.zdberstkatid	2132560-1