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

Background: 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. methods: 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. results: 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. conclusions: 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.