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Efficacy and safety of adding erdosteine in acute exacerbations of COPD (AECOPD): a comparative analysis with the standard treatment

Introduction: AECOPD are associated with increased airway-systemic inflammation and oxidative stress. Erdosteine (E), an original pro-thiol donor with mucolytic and antibacterial activity, acts also as an antioxidant, anti-inflammatory agent both in stable and AECOPD. Objective: We evaluated the effectiveness of adding E to the standard treatment (ST) in AECOPD. Methods: It had been conducted a comprehensive literature search for selected double-blind, randomized, placebo-controlled clinical trials (RCTs) primarily investigating the efficacy of E+ST vs ST in AECOPD with a treatment duration up to 7 days. The improvement in clinical symptoms, sputum clearance, lung function and severe adverse events (SAEs) were the assessed outcomes. Results: Data obtained from 369 COPD patients were extracted from 6 RCTs published between 1988 and 2019. Due to the heterogeneity in the RCT designs and records, a quantitative meta-analysis could not be performed. Compared to ST, adding E (600 to 900 mg/day) induced a faster and significant reduction of individual outcomes: dyspnoea intensity (E+ST:-77.7% vs ST:-63.6%), cough frequency (-65,4% vs-44%), difficulty of expectorating (-68,9% vs-50%), sputum viscosity (-68% vs-38,4), FEV1 (+19% vs+4.8%). These clinical differences were significant versus controls. No SAEs were reported with E in the RCTs. Conclusions: These results highlight that adding E to AECOPD standard therapy results in a faster improvement of clinical symptoms, and spirometric data. In fact, previous studies have shown Erdosteine’s relevant in vitro and in vivo antioxidant activity which might contribute to reduce the burst of airway inflammation in AECOPD