Efficacy and Safety of Inhaled Dry Powder Mannitol in Treating Cystic Fibrosis: A Meta-Analysis and Systematic Review of Randomized Trials

Background: Inhaled dry powder mannitol is an osmotic agent with a potential to improve lung functions in Cystic Fibrosis (CF) patients and possibly act as a disease modifying agent. Aim: Primary outcomes are to evaluate the improvement of lung functions. Methods Study selection criteria: Randomized trials that evaluated the improvement of lung functions in CF patients with the use of inhaled dry powder mannitol. Data collection & extraction: Articles were searched in Medline, Pubmed, and Ovid journals. Statistical method: Pooled proportions were calculated using fixed and random effects model. Results: Initial search identified 387 reference articles, of which 31 articles were selected and reviewed. Data was extracted from 6 studies (N = 771) which met the inclusion criteria. After the treatment duration (median12 weeks), FEV1% increased by 7.23 (95% CI = 6.88 to 7.58) and 2.77 (95% CI = 2.57 to 2.97) in the pooled patients of treatment and control groups respectively. FEV1 (in ml) improved by 114.12 (95% CI = 108.96 to 119.29) and 6.80 (95% CI = 6.13 to 7.48) in treatment and control groups respectively. Odds ratio for pharyngeal pain, cough, hemoptysis and headache in treatment group compared to control group were 1.52 (95% CI = 0.91 to 2.52), 1.27 (95% CI = 0.85 to 1.90), 1.82 (95% CI = 0.97 to 3.39) and 0.80 (95% CI = 0.54 to 1.19) respectively. Conclusion: Inhaled mannitol may be used as a chronic disease modifying treatment in patients with pulmonary CF and possibly improve the overall outcomes.