Evidence on Glutathione and Boosters for Prevention of Chemotherapy-Induced Neuropathy: A Systematic Review and Network Meta-Analysis.
Min Jung Geum, Jinyoung Jeon, JinYoung Moon et al.
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In 30 seconds
This systematic review and network meta-analysis compared glutathione (GSH) and GSH boosters for preventing chemotherapy-induced peripheral neuropathy (CIPN), drawing on 25 randomised controlled trials involving 1625 patients. No intervention significantly reduced all-grade CIPN versus placebo. For grade 3/4 CIPN, N-acetylcysteine (OR 0.19, 95% CrI 0.05-0.63), GSH (OR 0.34, 95% CrI 0.13-0.79) and vitamin E (OR 0.33, 95% CrI 0.11-0.91) were associated with lower incidence. N-acetylcysteine ranked highest, but these findings were not retained in analyses limited to double-blind studies and remain preliminary.
Key findings
- Across 25 RCTs involving 1625 patients, no intervention significantly reduced all-grade CIPN compared with placebo.
- N-acetylcysteine was associated with lower grade 3/4 CIPN incidence versus placebo (OR 0.19, 95% CrI 0.05-0.63).
- GSH (OR 0.34, 95% CrI 0.13-0.79) and vitamin E (OR 0.33, 95% CrI 0.11-0.91) were also associated with reduced grade 3/4 CIPN.
- The severe-CIPN findings were not retained in analyses restricted to double-blind studies.
Why it matters
CIPN can impair quality of life and affect cancer treatment. The review suggests that some agents may be associated with fewer severe cases, even though none clearly reduced CIPN overall. The loss of findings in double-blind-only analyses underscores uncertainty and the need to distinguish promising signals from established preventive benefit.
What to keep in mind
The findings were not retained in analyses restricted to double-blind studies, and the authors describe the associations as preliminary; further adequately powered trials are needed.