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N-Acetylcysteine for non-paracetamol drug-induced liver injury: A systemic review

Aims: There are limited therapeutic options for drug-induced liver injury (DILI). N-acetylcysteine (NAC ) is known to be of benefit in management of DILI due to paracetamol overdose and may also be useful in the management of non-paracetamol DILI. Our objective was to systematically review evidence...

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Main Author: Chughlay, Mohamed Farouk
Other Authors: Cohen, Karen
Format: Thesis
Language:English
Published: Division of Clinical Pharmacology 2016
Subjects:
Clinical Pharmacology
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access_status_str Open Access
author Chughlay, Mohamed Farouk
author2 Cohen, Karen
author_browse Chughlay, Mohamed Farouk
Cohen, Karen
author_facet Cohen, Karen
Chughlay, Mohamed Farouk
author_sort Chughlay, Mohamed Farouk
collection Thesis
description Aims: There are limited therapeutic options for drug-induced liver injury (DILI). N-acetylcysteine (NAC ) is known to be of benefit in management of DILI due to paracetamol overdose and may also be useful in the management of non-paracetamol DILI. Our objective was to systematically review evidence for the use of NAC as a therapeutic option for non-paracetamol DILI. Methods: We conducted a systematic review of the benefit and harm of NAC in non-paracetamol DILI. We searched for randomized controlled trials (RCTs) and prospective cohort studies. We searched several bibliographic databases (including PubMed, Scopus, CINAHL, CENTRAL), grey literature sources, conference proceedings and ongoing trials. Our pre-specified primary outcomes were all cause and DILI related mortality, time to normalisation of liver biochemistry and adverse events. Secondary outcomes were proportion receiving liver transplant, time to transplantation, transplant-free survival and hospitalization duration. Two reviewers independently assessed studies for inclusion and quality and extracted data. Results: We identified one RCT of NAC versus placebo in patients with non-paracetamol acute liver failure. There was no difference in the primary outcomes of overall survival at 3-weeks between NAC [70%, 95% Confidence Interval (CI)= 60% to 81%, n=81 ] and placebo (66%, 95% C I= 56% to 77%, n=92 ). NAC significantly improved the secondary outcomes of transplant-free survival compared with placebo : 40% NAC ( 95% CI= 28% to 51%) versus 27% placebo ( 95% CI= 18% to 37%). A subgroup analysis according to aetiology found improved transplant-free survival in patients with non-paracetamol DILI; NAC (58%, n=19 ) versus placebo (27%, n=26 ); odds ratio (OR) 0.27 (95% CI= 0.076 to 0.942 ). O verall survival was similar NAC ( 79% ) v ersus placebo ( 65% ); OR 0.5 0 ( 95% CI= 0.13 to 1.98 ). Conclusion : Current available evidence is limited and does not allow for any firm conclusions to be made regarding the role of NAC in non-paracetamol DILI. We therefore highlight the need for further research in this area.
format Thesis
id oai:open.uct.ac.za:11427/20294
institution University of Cape Town (South Africa)
language eng
last_indexed 2026-06-10T12:34:28.941Z
license_str Not specified — see source repository
provenance_str_mv Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository
publishDate 2016
publishDateRange 2016
publishDateSort 2016
publisher Division of Clinical Pharmacology
publisherStr Division of Clinical Pharmacology
record_format dspace
source_str UCTD — University of Cape Town Open Access Repository
spelling oai:open.uct.ac.za:11427/20294 N-Acetylcysteine for non-paracetamol drug-induced liver injury: A systemic review Chughlay, Mohamed Farouk Cohen, Karen Clinical Pharmacology Aims: There are limited therapeutic options for drug-induced liver injury (DILI). N-acetylcysteine (NAC ) is known to be of benefit in management of DILI due to paracetamol overdose and may also be useful in the management of non-paracetamol DILI. Our objective was to systematically review evidence for the use of NAC as a therapeutic option for non-paracetamol DILI. Methods: We conducted a systematic review of the benefit and harm of NAC in non-paracetamol DILI. We searched for randomized controlled trials (RCTs) and prospective cohort studies. We searched several bibliographic databases (including PubMed, Scopus, CINAHL, CENTRAL), grey literature sources, conference proceedings and ongoing trials. Our pre-specified primary outcomes were all cause and DILI related mortality, time to normalisation of liver biochemistry and adverse events. Secondary outcomes were proportion receiving liver transplant, time to transplantation, transplant-free survival and hospitalization duration. Two reviewers independently assessed studies for inclusion and quality and extracted data. Results: We identified one RCT of NAC versus placebo in patients with non-paracetamol acute liver failure. There was no difference in the primary outcomes of overall survival at 3-weeks between NAC [70%, 95% Confidence Interval (CI)= 60% to 81%, n=81 ] and placebo (66%, 95% C I= 56% to 77%, n=92 ). NAC significantly improved the secondary outcomes of transplant-free survival compared with placebo : 40% NAC ( 95% CI= 28% to 51%) versus 27% placebo ( 95% CI= 18% to 37%). A subgroup analysis according to aetiology found improved transplant-free survival in patients with non-paracetamol DILI; NAC (58%, n=19 ) versus placebo (27%, n=26 ); odds ratio (OR) 0.27 (95% CI= 0.076 to 0.942 ). O verall survival was similar NAC ( 79% ) v ersus placebo ( 65% ); OR 0.5 0 ( 95% CI= 0.13 to 1.98 ). Conclusion : Current available evidence is limited and does not allow for any firm conclusions to be made regarding the role of NAC in non-paracetamol DILI. We therefore highlight the need for further research in this area. 2016-07-11T13:50:23Z 2016-07-11T13:50:23Z 2016 Master Thesis Masters MMed http://hdl.handle.net/11427/20294 eng application/pdf application/pdf Division of Clinical Pharmacology Faculty of Health Sciences University of Cape Town
spellingShingle Clinical Pharmacology
Chughlay, Mohamed Farouk
N-Acetylcysteine for non-paracetamol drug-induced liver injury: A systemic review
thesis_degree_str Master's
title N-Acetylcysteine for non-paracetamol drug-induced liver injury: A systemic review
title_full N-Acetylcysteine for non-paracetamol drug-induced liver injury: A systemic review
title_fullStr N-Acetylcysteine for non-paracetamol drug-induced liver injury: A systemic review
title_full_unstemmed N-Acetylcysteine for non-paracetamol drug-induced liver injury: A systemic review
title_short N-Acetylcysteine for non-paracetamol drug-induced liver injury: A systemic review
title_sort n acetylcysteine for non paracetamol drug induced liver injury a systemic review
topic Clinical Pharmacology
url http://hdl.handle.net/11427/20294
work_keys_str_mv AT chughlaymohamedfarouk nacetylcysteinefornonparacetamoldruginducedliverinjuryasystemicreview

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