RESUMO
Pirfenidone and nintadanib are two new anti-fibrotic drugs that have been shown to reduce the decline of lung function in patients with idiopathic pulmonary fibrosis (IPF) in multiple clinical trials,and have become first-line drugs for the treatment of IPF.However there are lack of references for how to choose between these two drugs. This article collected the latest research literatures related to pirfenidone or nintedanib,and summarized pharmacokinetics, pharmacological mechanism, clinical trials and safety profile of pirfenidone and nintedanib, so as to provide reference for clinical drug use. Evidences show both pirfenidone and nintedanib can reduce the decline of lung function and delay disease progression in mild-to-moderte IPF patients, and may have similar effects on severe IPF patients. There are large differences in pharmacological mechanisms, pharmacokinetics, and adverse events between these two new antifibrotic drugs. However, in terms of efficacy, there is no clear evidence to show which drug is better. Clinicians choosing drug should base on pharmacokinetic characteristics and adverse events between these two drugs.
RESUMO
OBJECTIVE: To investigate the efficacy and safety of N-acetylcysteine(NAC) in treatment of patients with idiopathic pulmonary fibrosis(IPF) and provide evidence for clinical medication. METHODS: We electronically searched PubMed, The Cochrane Library, EM base, CNKI, Wan Fang Data and VIP database for all relevant studies about NAC in management of patients with IPF from the date of database establishment to September 2017. Two independent reviewers exact data and assess the quality of included studies. All statistical analyses were performed using RevMan V.5.3. RESULTS: A total of nine studies were included for final Meta-analysis, involving 666 patients. Our Meta-analysis indicated that NAC group can significantly decrease the change in the forced vital capacity(FVC) [MD=0.14, 95%CI(-0.00, 0.28), P=0.05], percentage of predicted vital capacity(VC%) [MD=3.84, 95%CI(1.02, 6.66), P=0.008] and carbon monoxide diffusing capacity(DLco%) [MD=0.10, 95%CI(0.03, 0.17), P=0.006] when compared with control group, and there were no significant difference in the change of six minutes walking test distance [MD=17.58,95%CI(-4.23,39.38), P=0.008], rates of adverse events[OR=1.28, 95%CI(0.83,1.98), P=0.26], or death [OR=0.98, 95%CI(0.40,2.43), P=0.06] between NAC group and control group. A further subgroup analysis according to route of administration indicated that inhalation administration NAC group can significant decrease the change in FVC(P=0.04), whereas oral administration NAC group had no statistically difference in the change of FVC when compared with control group(P=0.48). Both inhalation and oral administration NAC group had no statistically difference in rates of adverse events or death rates when compared with control group(P<0.05). CONCLUSION: Present evidence shows that NAC is well tolerated and can significantly decrease the decline in lung function but can not decrease rates of death. Besides, different routes of administration may affect the efficacy of NAC, inhalation administration seems better than oral administration.
RESUMO
This study was purposed to investigate the relationship between tissue factor associated platelet microparticles and thrombosis of patients with lymphoma by detecting the density of platelet microparticles and the tissue factor coagulative activity, and to evaluate the possibility of tissue factor coagulative activity for predication of thrombosis in lymphoma patients. This study was divided into 3 groups: A group including 50 healthy persons who did not take any drugs and had no hypercoagulation diseases; B group including 50 cases of lymphoma without thrombosis, and C group including 8 cases of lymphoma with thrombosis. The plasma was isolated from venous blood by centrifugation. The density of platelet microparticles was detected by flow cytometry; the tissue factor coagulative activity of plasma was measured by chromogenic substrate. The results indicated that compared with group A, the density of platelet microparticles increased in group B. Compared with group B, group C had significantly higher density of platelet microparticles and tissue factor coagulative activity (P < 0.01). It is concluded that the density of tissue factor associated platelet microparticle has predictive value for lymphoma with thrombosis, which can be used as target of clinical test.