N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis: randomized, placebo-controlled pilot study

World J Gastroenterol. 2008 May 14;14(18):2851-7. doi: 10.3748/wjg.14.2851.

Abstract

Aim: To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine (NAC) co-administration with mesalamine in ulcerative colitis (UC) patients.

Methods: Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine (2.4 g/d) plus N-acetyl-L-cysteine (0.8 g/d) (group A) or mesalamine plus placebo (group B). Patients were monitored using the Modified Truelove-Witts Severity Index (MTWSI). The primary endpoint was clinical remission (MTWSI < or = 2) at 4 wk. Secondary endpoints were clinical response (defined as a reduction from baseline in the MTWSI of > or = 2 points) and drug safety. The serum TNF-alpha, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment.

Results: Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine (group A) and mesalamine plus placebo (group B) respectively (OR = 1.71; 95% CI: 0.46 to 6.36; P = 0.19; NNT = 7.7). Analysis of variance (ANOVA) of data indicated a significant reduction of MTWSI in group A (P = 0.046) with respect to basal condition without significant changes in the group B (P = 0.735) during treatment. Clinical responses were 66% (group A) vs 44% (group B) after 4 wk of treatment (OR = 2.5; 95% CI: 0.64 to 9.65; P = 0.11; NNT = 4.5). Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.

Conclusion: In group A (oral NAC combined with mesalamine) contrarily to group B (mesalamine alone), the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetylcysteine / adverse effects
  • Acetylcysteine / therapeutic use*
  • Adult
  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Chemokine CCL2 / blood
  • Colitis, Ulcerative / blood
  • Colitis, Ulcerative / drug therapy*
  • Drug Therapy, Combination
  • Female
  • Free Radical Scavengers / adverse effects
  • Free Radical Scavengers / therapeutic use*
  • Glutathione / blood
  • Humans
  • Interleukin-6 / blood
  • Interleukin-8 / blood
  • Male
  • Mesalamine / adverse effects
  • Mesalamine / therapeutic use*
  • Middle Aged
  • Pilot Projects
  • Severity of Illness Index
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / blood

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • CCL2 protein, human
  • Chemokine CCL2
  • Free Radical Scavengers
  • Interleukin-6
  • Interleukin-8
  • Tumor Necrosis Factor-alpha
  • Mesalamine
  • Glutathione
  • Acetylcysteine