The Effect Of Carbocisteine On Patients With Copd: A Systematic Review And Meta-analysis

Objective:The effect of Carbocisteine on patients with stable COPD was analyzed in the thesis.Methods:Methods of systematic reviews and meta-analyses were employed for this study,including randomized,placebo-controlled studies of oral Carbocisteine for a period of at least 3months.Our findings included studies of adults(older than 18 years old)with COPD which was defined by the criteria of the Global Initiative for Chronic Obstructive Lung Disease 2017 or the World Health Organization.Studies were excluded that were published as protocol or written in non-English language.The following electronic bibliographic databases were searched:MedLine,Embase,Cochrane Library and Web of Science;as well as gray literature database OpenSIGLE and the clinical trial registers such as ClinicalTrials.gov register and International Clinical Trials Registry Platform Search Portal.The search for randomized,controlled trials published up to September 1,2016.The primary outcomes included exacerbation rates(total number).The secondary outcomes were:1.measurement of the lung function,including FEV1;2.the rates of hospitalization and all-cause mortality;3.the number of patients with at least one exacerbation;4.the quality of the patients'life 5.Acute exacerbations that need hospital admission 6.the adverse effects.(The registration number of PROSPERO:42016047078).Results:The thesis identified 22 randomized clinical trials.In all,four studies met the inclusion criteria,with a total of 1357patients.A significant decrease was seen in the rate of exacerbations in the Carbocisteine group compared with the placebo group(three studies:n=1215;MD-0.43;95%CI-0.57 to-0.29,I~2=60%,P<0.00001).A critical difference was noted in the number of patients with at least one exacerbation compared with placebo(three studies:n=1215;RR 0.86;95%CI 0.78 to 0.95,I~2=84%,P=0.002).Similarly,an obvious decrease could be found in the quality of the patients'life in the Carbocisteine group compared with the placebo group(two studies:n=849;MD-6.29;95%CI-9.30 to-3.27,I~2=61%).In terms of adverse effects,no noticeable difference was seen between carbocisteine groupand placebo group.As for exacerbation rates,the subgroup with the population of non-Chinese showed a great reduction in the Carbocisteine group(two studies:n=508,MD=-0.34;95%CI-0.90 to-0.40,I~2=2%,P<0.00001).The subgroup with Chinese Patients,however,showed no difference in the risk of the outcome(one study:n=707,MD=-0.34;95%CI-0.51 to-0.17,P<0.0001).In the outcome of the number of patients with at least one exacerbation,the subgroup without Chinese patients showed a significant difference(two studies:n=508;RR=0.66;95%CI 0.54 to 0.81,I~2=0%,P<0.0001)compared to placebo,whereas in the subgroup with Chinese,no difference was noted in the risk of the outcome(one study:n=707;RR=0.98;95%CI 0.87 to 1.09,P=0.68).Conclusion:1.The Long-term use of Carbocisteine may be associated with lower exacerbation rates,the smaller number of patients with at least one exacerbation and the higher quality of life of patients with COPD.2.The effect of Carbocisteine was different in patients of various races or individuals of the same race.Less effects may be shown in Chinese patients with stable COPD compared with patients of other races.If the gene detection of the metabolism of Carbocisteine could not be completed,Carbocisteine would not be recommend as the first line treatment in patients with stable COPD.Carbocisteine may be appropriate to patients who could not tolerate the first line medicine.It may also be used as an additional treatment which adds on the first line treatment.