Efficacy and safety of N-acetylcysteine for the treatment of non-acetaminophen-induced acute liver failure: an updated systematic review and meta-analysis

Jawaid, Haris; Ali, Muhammad Mustafa; Khan, Muhammad Uzair; Saad, Sami; Shaikh, Majid Ahmed

doi:10.5114/ceh.2021.107171

Cited by 4 publications

(5 citation statements)

References 18 publications

(19 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Eight systematic reviews ( Table 2 ) ( 65 , 67 - 70 , 74 , 75 , 82 ) provide useful insights into the evolution of evidence. While the earlier analyses note potential utility of NAC based primarily on retrospective case reports and series, recent reviews included randomized controlled trials (RCTs) and concluded significant benefit in terms of transplant-free and post-transplantation survival.…”

Section: Resultsmentioning

confidence: 99%

Repurposing N-acetylcysteine for management of non-acetaminophen induced acute liver failure: an evidence scan from a global health perspective

Jerome,

Zahn,

Abner

et al. 2024

Transl Gastroenterol Hepatol

View full text Add to dashboard Cite

Background The World Health Organization (WHO)’s Essential Medicines List (EML) plays an important role in advocating for access to key treatments for conditions affecting people in all geographic settings. We applied our established drug repurposing methods to one EML agent, N-acetylcysteine (NAC), to identify additional uses of relevance to the global health community beyond its existing EML indication (acetaminophen toxicity). Methods We undertook a phenome-wide association study (PheWAS) of a variant in the glutathione synthetase ( GSS ) gene in approximately 35,000 patients to explore novel indications for use of NAC, which targets glutathione. We then evaluated the evidence regarding biologic plausibility, efficacy, and safety of NAC use in the new phenotype candidates. Results PheWAS of GSS variant R418Q revealed increased risk of several phenotypes related to non-acetaminophen induced acute liver failure (ALF), indicating that NAC may represent a therapeutic option for treating this condition. Evidence review identified practice guidelines, systematic reviews, clinical trials, retrospective cohorts and case series, and case reports. This evidence suggesting benefit of NAC use in this subset of ALF patients. The safety profile of NAC in this literature was also concordant with existing evidence on safety of this agent in acetaminophen-induced ALF. Conclusions This body of literature indicates efficacy and safety of NAC in non-acetaminophen induced ALF. Given the presence of NAC on the EML, this medication is likely to be available across a range of resource settings; promulgating its use in this novel subset of ALF can provide healthcare professionals and patients with a valuable and safe complement to supportive care for this disease.

show abstract

Section: Resultsmentioning

confidence: 99%

Repurposing N-acetylcysteine for management of non-acetaminophen induced acute liver failure: an evidence scan from a global health perspective

Jerome,

Zahn,

Abner

et al. 2024

Transl Gastroenterol Hepatol

View full text Add to dashboard Cite

show abstract

“…13 The role of NAC in EHS-ALI/ALF remains unclear, but meta-analyses and trials have found that NAC is beneficial in nonacetaminophen ALF, especially in patients with early encephalopathy. 11,15,16 In the absence of larger studies confirming efficacy, giving NAC to patients with EHS-induced ALF early is likely prudent given the relative safety of the therapeutic. This case report demonstrates that in patients with EHS-ALI/ ALF, the timing of LT can be difficult to determine.…”

Section: Discussionmentioning

confidence: 99%

Exertional Heat Stroke-Induced Acute Liver Failure and Liver Transplantation

et al. 2022

View full text Add to dashboard Cite

Exertional heat stroke is a medical emergency characterized by excessive heat production and inadequate heat dissipation usually after heavy exertion in hot and humid climates and can be associated with multiorgan failure. Treatment is largely supportive, but liver transplantation (LT) may be necessary in select patients. Here, we report the case of a 44-year-old runner who was found unconscious after a 5-mile run and developed acute liver failure. He underwent successful LT 1 week later when he developed encephalopathy. This case report illustrates the importance of early LT referral in patients with exertional heat stroke-induced acute liver failure.

show abstract

“…However, there is inconsistent evidence for a role of NAC in nonparacetamol ALF. Five systematic reviews with different methodological profiles conducted on the topic between 2020 and 2021 are contradictory and mostly based on low-quality studies [61 ▪ –65 ▪ ]. On the basis of the lack of evidence of beneficial effects on transplant-free survival, a Cochrane review did not endorse the current guidelines suggestion to use NAC in adults with nonparacetamol-related ALF [64 ▪ ].…”

Section: Managementmentioning

confidence: 99%

Acute liver failure

Vasques

Cavazza

Bernal

2022

Current Opinion in Critical Care

View full text Add to dashboard Cite

Purpose of reviewPresent an outline of acute liver failure, from its definition to its management in critical care, updated with findings of selected newer research. Recent findingsSurvival of patients with acute liver failure has progressively improved. Intracranial hypertension complicating hepatic encephalopathy is now much less frequent than in the past and invasive ICP monitoring is now rarely used. Early renal replacement therapy and possibly therapeutic plasma exchange have consolidated their role in the treatment. Further evidence confirms the low incidence of bleeding in these patients despite striking abnormalities in standard tests of coagulation and new findings of abnormalities on thromboelastographic testing. Specific coagulopathy profiles including an abnormal vWF/ADAMTS13 ratio may be associated with poor outcome and increased bleeding risk. Use of Nacetylcysteine in nonparacetamol-related cases remains unsupported by robust clinical evidence. New microRNA-based prognostic markers to select patients for transplantation are described but are still far from widespread clinical applicability; imaging-based prognostication tools are also promising. The use of extracorporeal artificial liver devices in clinical practice is yet to be supported by evidence. SummaryMedical treatment of patients with acute liver failure is now associated with significantly improved survival. Better prognostication and selection for emergency liver transplant may further improve care for these patients.

show abstract

Efficacy and safety of N-acetylcysteine for the treatment of non-acetaminophen-induced acute liver failure: an updated systematic review and meta-analysis

Cited by 4 publications

References 18 publications

Repurposing N-acetylcysteine for management of non-acetaminophen induced acute liver failure: an evidence scan from a global health perspective

Repurposing N-acetylcysteine for management of non-acetaminophen induced acute liver failure: an evidence scan from a global health perspective

Exertional Heat Stroke-Induced Acute Liver Failure and Liver Transplantation

Acute liver failure

Contact Info

Product

Resources

About