Mucolytic drugs at high doses may be effective in protecting patients with chronic pulmonary obstructive disease (COPD) against exacerbations, especially when treated for longer than 1 year, according to a meta-analysis published in COPD: Journal of Chronic Obstructive Pulmonary Disease.
The researchers identified 11 randomized clinical trials that included 1587 patients with COPD treated with a mucolytic agent and 1577 patients treated with placebo. There were differences in study designs and baseline patient characteristics.
Results demonstrated that mucolytic agents significantly reduced the risk for COPD exacerbations in patients with COPD when compared with placebo (odds ratio [OR], 0.51; 95% CI, 0.39-0.67; P <.001). The most effective mucolytics were carbocysteine, erdosteine, and N-acetylcysteine (surface under the cumulative ranking curve, 68%-79%). N-acetylcysteine significantly protected at 1200 mg/d (OR, 0.56; 95% CI, 0.35-0.92; P <.05), but not 600 mg/d (OR 0.95; 95% CI, 0.85-1.07; P ≥.05).
The investigators concluded that mucolytic agents are effective in protecting patients with COPD against exacerbations, with carbocysteine, erdosteine, and N-acetylcysteine at high doses. Further, there was greater protection in patients treated with these mucolytic agents for 1 year or longer.
Disclosures: Several authors disclosed financial ties to various pharmaceutical companies, including Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, and Novartis, among others.
Cazzola M, Rogliani P, Calzetta L, Hanania NA, Matera MG. Impact of mucolytic agents on COPD exacerbations: a pair-wise and network meta-analysis [published online July 28, 2017]. COPD. doi:10.1080/15412555.20171347918