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Comparative Efficacy / Evaluation With Other Therapies

上次有跟各位提過，Acetylcysteine的多數作用，現在補充一向跟他類似作用的藥物及效果

你可以先參考這邊：

[Micromedex][01] acetylcysteine 適應症整理

[Micromedex][02]Acetylcysteine適應症整理
[Micromedex][03]Acetylcysteine適應症整理
[Micromedex][04]Acetylcysteine 適應症整理
[Micromedex][05]Acetylcysteine適應症整理

或是你直接利用索引，找所有相關資料：

http://mulicia.pixnet.net/blog/search/acetylcysteine/1

Ambroxol

Cystic fibrosis

a) A clinical trial compared the efficacy of oral ambroxol and 上次有跟各位提過， as a mucolytic in 36 pediatric patients with cystic fibrosis (Ratjen et al, 1985). Patients were randomized to receive either ambroxol 30 milligrams (mg), N-acetylcysteine 200 mg, or placebo 3 times a day for 12 weeks. Thirty-two patients completed the study. All changes in pulmonary function test parameters were below the statistical detection limit (p greater than 0.05); no significant clinical differences were found between the 3 groups. Significant impairment was noted in the placebo group, but was felt to be coincidental. None of the patients' parents reported improvement and 66% of the total felt that their child had received placebo. A therapeutic effect with either drug was not demonstrated, thus more study is needed.

Ascorbic Acid

Radiographic contrast agent nephropathy; Prophylaxis

a) In a randomized, 2-center, double-blind study (Renal Insufficiency Following Contrast Media Administration trial (REMEDIAL)) in patients with chronic kidney disease, volume supplementation by sodium bicarbonate plus N-acetylcysteine (NAC) was superior to the combination of normal saline with NAC alone or with the addition of ascorbic acid in preventing contrast agent-induced nephrotoxicity (CIN) in patients at medium to high risk. Patients (n=326) with serum creatinine of 2 or greater milligrams per deciliter (mg/dL) and/or estimated glomerular filtration rate of less than 40 milliliters per minute per 1.73 squared meter (mL/min/1.73 m(2)), were randomly assigned to prophylactic administration of 0.9% saline infusion plus NAC (n=111), sodium bicarbonate infusion plus NAC (n=108), and 0.9% saline plus ascorbic acid plus NAC (n=107). The primary end point was the development of CIN, defined as an increase of 25% or greater in the creatinine concentration 48 hours after the procedure or the need for dialysis . A nonionic, iso-osmolar contrast agent (iodixanol) was used in all patients. Overall, the saline plus NAC, the bicarbonate plus NAC and the saline plus NAC plus ascorbic acid groups had similar amount of contrast media administered (179 +/- 102 mL, 169 +/- 92 mL, and 169 +/- 94 mL (mean +/- SD), respectively; p=0.69) and had similar mean contrast nephropathy risk scores (9.1 +/- 3.4, 9.5 +/- 3.6, and 9.3 +/- 3.6; p=0.21). CIN developed in 9.9% (11/111) of patients in the saline plus NAC group, in 1.9% (2/108) of patients in the bicarbonate plus NAC group (p=0.019 by Fisher exact test versus saline plus NAC group), and in 10.3% (11/107) of patients in the saline plus ascorbic acid plus NAC group (p=1 versus saline plus NAC group). An increase of 0.5 mg/dL or greater in the serum creatinine concentration and a decrease of estimated glomerular filtration rate of 25% or greater at 48 hours after contrast exposure (the additional efficacy end points) were observed less often in the bicarbonate plus NAC group than in the saline plus NAC group and saline plus ascorbic acid plus NAC group (Briguori et al, 2007).

Cysteamine

Acetaminophen overdose

a) Intravenous N-acetylcysteine was considered more effective than intravenous cysteamine in preventing hepatic complications of severe acetaminophen overdose in one study (Prescott, 1981). Other advantages of N-acetylcysteine over cysteamine include lesser toxicity and a possibly longer time interval of efficacy (15 versus 10 hours following overdose) (Davis, 1986; Prescott, 1981). Oral or intravenous N-acetylcysteine is thus preferable to cysteamine in this setting.

Fenoldopam Mesylate

Radiographic contrast agent nephropathy

a) There was no significant difference in the ability of oral N-acetylcysteine and intravenously (IV) administered fenoldopam to prevent declines in renal function or the incidence of contrast-induced nephropathy following contrast dye administration during cardiac catheterization in mildly renal insufficient adults, according to a prospective, randomized, parallel-group study (n=84). Patients 19 years and older who had a higher risk of contrast-induced nephropathy, defined as baseline serum creatinine greater than 1.2 milligrams/deciliter (mg/dL) with no change greater than 0.1 mg/dL over 2 assessments prior to catheterization, or who were diabetic were included in the study. Patients were randomized to receive either acetylcysteine 600 mg orally twice daily for a minimum of 3 doses before and 1 dose after catheterization (n=44), or fenoldopam 0.1 microgram/kilogram/minute IV started 1 to 2 hours before and continued 6 hours after catheterization (n=40). All patients received IV hydration and non-ionic, low, or iso-osmolar contrast dyes. In an intent-to-treat analysis over 72 hours following catheterization, there were no significant differences in the mean change in serum creatinine, 0.2 +/- 0.72 mg/dLin the N- acetylcysteine group and 0.08 +/- 0.48 mg/dL in fenoldopam group (p=0.4), with a corresponding incidence of contrast-induced nephropathy of 11.4% (5/44) vs 20% (8/40) (p=0.4), respectively. In multivariate analysis there were no significant differences seen for mean change in serum creatinine (p=0.7) or in contrast-induced nephropathy (p=0.3) when evaluated by diabetes status, contrast volume, heart failure, or gender. The results of the study have been limited due to the study was underpowered which terminated prior to the targeted 140 patient enrollment (Ng et al, 2006).

Mesna

Bronchitis, chronic

a) In a crossover trial of 12 patients with chronic bronchitis, nebulized acetylcysteine 10% plus isoproterenol was compared with mesna 10% with isoproterenol. Both combinations were compared with a saline control and saline plus isoproterenol. Comparison of the treatment involved sputum consistency, sputum volume, spirometric measurements, and clinical course. No statistically significant difference was seen between 10% mesna and 10% acetylcysteine. Subjective improvement was related to the isoproterenol rather than to the mucolytic agents (Hirsch et al, 1970).

Sodium Bicarbonate

Radiographic contrast agent nephropathy; Prophylaxis

a) In a randomized, 2-center, double-blind study (Renal Insufficiency Following Contrast Media Administration trial (REMEDIAL)) in patients with chronic kidney disease, volume supplementation by sodium bicarbonate plus N-acetylcysteine (NAC) was superior to the combination of normal saline with NAC alone or with the addition of ascorbic acid in preventing contrast agent-induced nephrotoxicity (CIN) in patients at medium to high risk. Patients (n=326) with serum creatinine of 2 or greater milligrams per deciliter (mg/dL) and/or estimated glomerular filtration rate of less than 40 milliliters per minute per 1.73 squared meter (mL/min/1.73 m(2)), were randomly assigned to prophylactic administration of 0.9% saline infusion plus NAC (n=111), sodium bicarbonate infusion plus NAC (n=108), and 0.9% saline plus ascorbic acid plus NAC (n=107). The primary end point was the development of CIN, defined as an increase of 25% or greater in the creatinine concentration 48 hours after the procedure or the need for dialysis . A nonionic, iso-osmolar contrast agent (iodixanol) was used in all patients. Overall, the saline plus NAC, the bicarbonate plus NAC and the saline plus NAC plus ascorbic acid groups had similar amount of contrast media administered (179 +/- 102 mL, 169 +/- 92 mL, and 169 +/- 94 mL (mean +/- SD), respectively; p=0.69) and had similar mean contrast nephropathy risk scores (9.1 +/- 3.4, 9.5 +/- 3.6, and 9.3 +/- 3.6; p=0.21). CIN developed in 9.9% (11/111) of patients in the saline plus NAC group, in 1.9% (2/108) of patients in the bicarbonate plus NAC group (p=0.019 by Fisher exact test versus saline plus NAC group), and in 10.3% (11/107) of patients in the saline plus ascorbic acid plus NAC group (p=1 versus saline plus NAC group). An increase of 0.5 mg/dL or greater in the serum creatinine concentration and a decrease of estimated glomerular filtration rate of 25% or greater at 48 hours after contrast exposure (the additional efficacy end points) were observed less often in the bicarbonate plus NAC group than in the saline plus NAC group and saline plus ascorbic acid plus NAC group (Briguori et al, 2007).