The effect of Vitamin E and N-acetyl cysteine on oxidative status and hemoglobin level in transfusion-dependent thalassemia patients: A systematic review and meta-analysis

This meta-analysis was conducted to summarize the comparative effect of Vitamin E and N-acetyl cysteine (NAC) on oxidative status, including total antioxidant capacity (TAC), total oxidative stress (TOS), oxidative stress index (OSI), and hemoglobin (Hb) in patients with TDT.

This systematic review and meta-analysis was done according to the PRISMA checklist. We searched databases including Web of Science (ISI), Scopus, Medline (via PubMed), and Embase. Meta-analysis was done using Stata statistical software version 16.0.

Finally, four randomized-controlled trials (RCT) for Vitamin E and three RCTs for NAC were included. Our meta-analyses and review showed a significant increase in the weighted mean differences (WMD) of Hb and a significant decrease in the WMD of TOS and OSI in children subgroup of Vitamin E. Also, based on the results of the review in the NAC group, a significant increase in the WMD of Hb and a significant decrease in the WMD of TOS and OSI were found in children.

Vitamin E showed a beneficial effect on improving anemia in TDT children. Moreover, both NAC and Vitamin E seems to be effective antioxidant supplements in children with TDT. More well-designed randomized, controlled trials for the effect of NAC and Vitamin E in TDT patients are recommended with more focus on the essential influencing factors on the oxidative status in these patients.