Nacetylcystein effect on decreasing ulcerative colitis flare during the period of glucocorticoid tapering: A clinical trial

Abstract

The use of antioxidant agents is suggested as a complementary therapy in UC patients for prevention of flares. Considering the potent antioxidant activity of N-acetylcysteine (NAC), in the present study we aimed to assess the effect of this supplement on remission maintenance in patients with ulcerative colitis (UC). Methods: In the present double-blind randomized controlled clinical trial, 168 volunteer UC patients who were on high dose corticosteroid for flare-up management, were recruited. The patients received 400 mg NAC or placebo twice daily for 16 weeks. Simultaneously, the prednisolone dose was tapered. The patients were followed up six more weeks post-intervention. The primary efficacy of the treatment was remaining in remission. The secondary outcomes were the endoscopic relapse, serum level of hs-CRP, hemoglobin, and fecal calprotectin level. Results: During 22 weeks follow up, 25 patients experienced relapses, six of them were in the NAC group and 19 of them were in the placebo group. There was a significant difference between the NAC and placebo groups regarding the relapse-free period (P=0.007). Compared with the NAC group, significantly more patients in the placebo group had an endoscopic relapse (p <0.001). At the end of the intervention period (16 weeks) and 6 weeks post-intervention, the mean fecal calprotectin, serum erythrocyte sedimentation rate, and hs-CRP levels were significantly lower in the NAC group compared with the placebo group (p<0.05).