Effects of three months of treatment with vitamin E and N-acetyl cysteine on the oxidative balance in patients with transfusion-dependent β-thalassemia

Ann Hematol. 2021 Mar;100(3):635-644. doi: 10.1007/s00277-020-04346-2. Epub 2020 Nov 20.


Oxidative stress is a major mechanism contributing to the progression of β-thalassemia. To assess the effect of vitamin E and N-acetyl cysteine (NAC) as antioxidant agents on total oxidative stress (TOS) status and total antioxidant capacity (TAC) in patients with transfusion-dependent β-thalassemia (TDT). In this open-label randomized controlled trial, from May to August 2019, 78 eligible patients with TDT over the age of 18 were enrolled. All patients were registered at the Thalassemia Clinic of Shiraz University of Medical Sciences in Southern Iran. Patients were randomly allocated to the NAC group (10 mg/kg/day, orally), vitamin E group (10 U/kg/day, orally), and control group. The duration of the study was 3 months. The mean age of the participants was 28.5 ± 5.1 (range: 18-41) years. At the end of the study, TOS significantly decreased only in the vitamin E group (mean difference (MD), 95% confidence interval (CI): 0.27 (0.03-0.50), P = 0.026). TAC significantly decreased in both supplemented groups at the 3rd month of treatment (NAC group: MD (95% CI): 0.11 (0.04-0.18), P = 0.002 and vitamin E group: 0.09 (0.01-0.16), P = 0.022 respectively). Hemoglobin did not significantly change at the end of the study in each group (P > 0.05). Mild transient adverse events occurred in 4 patients of the NAC group and 5 patients of the vitamin E group with no need to discontinue the treatment. Vitamin E can be a safe and effective supplement in improving oxidative stress in patients with TDT. Moreover, it seems that a longer duration of using antioxidant supplements needs to make clinical hematologic improvement in TDT patients.

Keywords: Antioxidants; N-Acetyl cysteine; Oxidative stress; Vitamin E; β-thalassemia.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acetylcysteine / administration & dosage*
  • Acetylcysteine / pharmacology
  • Adolescent
  • Adult
  • Antioxidants / administration & dosage
  • Antioxidants / analysis
  • Antioxidants / metabolism
  • Blood Transfusion
  • Dietary Supplements
  • Female
  • Humans
  • Iran
  • Male
  • Oxidants / blood
  • Oxidation-Reduction / drug effects
  • Oxidative Stress / drug effects*
  • Time Factors
  • Vitamin E / administration & dosage*
  • Vitamin E / pharmacology
  • Young Adult
  • beta-Thalassemia / blood
  • beta-Thalassemia / drug therapy*
  • beta-Thalassemia / therapy


  • Antioxidants
  • Oxidants
  • Vitamin E
  • Acetylcysteine