Effects of N-acetylcysteine on systemic lupus erythematosus disease activity and its associated complications: a randomized double-blind clinical trial study

Abstract

Backgrounds N-acetylcysteine (NAC) has broadly been used as an anti-oxidant agent in various types of diseases. This study aimed to assess the effect of NAC on the systemic lupus erythematosus (SLE) disease activity and outcome. Methods In this randomized, double-blind clinical trial study, 80 SLE patients were recruited that were classified into two groups: 40 patients received NAC (1800 mg/day; 3 times per day with 8-h intervals) for 3 months and 40 patients as the control group received normal therapies. Laboratory measurements and disease activity based on the British Isles Lupus Assessment Group (BILAG) and SLE Disease Activity Index (SLEDAI) were determined before the initiation of treatment and after the study time period. Results A statistically significant decrease in BILAG (P= 0.023) and SLEDAI (P= 0.034) scores after receiving NAC for a 3-month period was observed. BILAG (P= 0.021) and SLEDAI (P= 0.030) scores were significantly lower in NAC-receiving patients compared to the control group after 3 months. The disease activity in each organ based on BILAG score after treatment indicated a significant decrease in the NAC group compared to the baseline level in general (P=0.018), mucocutaneous (P=0.003), neurological (P=0.015), musculoskeletal (P=0.048), cardiorespiratory (P=0.047), renal (P=0.025), and vascular (P=0.048) complications. Analysis indicated a significant increase in CH50 level in the NAC group after treatment compared to the baseline level (P=0.049). No adverse event was reported by the study subjects. Conclusions It appears that the administration of 1800 mg/day NAC to SLE patients can decrease the SLE disease activity and its complications.

NETosis: an emerging therapeutic target in renal diseases

“…N-acetylcysteine (NAC) slightly reduces albumin/creatinine ratio and suppresses renal fibrosis in diabetic nephropathy in diabetic rat models (208,209). High-dose NAC decreased SLEDAI scores and BILAG classes significantly in a randomized double-blind clinical trial, though patients with acute flare threatening vital organs were excluded (210). Pre-and post-treatment with NAC in septic rats were protective against kidney injury while long-term administration of NAC worsened organ failure and did not improve albuminuria.…”

Emerging biologic therapies for systemic lupus erythematosus

“…Sirolimus is being evaluated in a phase II/III trial in LN (NCT04892212). Along this line, N-acetylcysteine (NAC) improved disease activity in association with reversal of mTOR activation in T cells [46,47]. NAC is being evaluated in a phase II trial in SLE (NCT00775476).…”

Metabolic Modulators in Cardiovascular Complications of Systemic Lupus Erythematosus

“…These vasculo-protective effects were associated with reduced Th17 infiltration. Recently, a randomized double-blind clinical trial study demonstrated that N-acetylcysteine treatment reduced vascular complications in SLE [134]. Idebenone, a synthetic quinone analog of coenzyme Q10, enhances electron transfer chain function by bypassing deficient complex I activity and increasing the amount of ATP synthesized, thereby improving mitochondrial physiology, reducing the aberrant production of mROS, the formation of NETs and the activation of the type I IFN pathway.…”