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N-acetylcysteine as adjuvant therapy for hospitalized Covid-19 patients: A single-center prospective cohort study

Afaghi et al., Caspian J Intern Med, doi:10.22088/cjim.14.3.553
Jun 2023  
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0 0.5 1 1.5 2+ Mortality 29% Improvement Relative Risk Ventilation 41% ICU admission 20% Hospitalization time 14% ΔSpO2 57% no CI N-acetylcysteine  Afaghi et al.  LATE TREATMENT Is late treatment with N-acetylcysteine beneficial for COVID-19? Prospective study of 462 patients in Iran (June 2020 - March 2021) Shorter hospitalization with N-acetylcysteine (p=0.002) Afaghi et al., Caspian J Intern Med, Jun 2023 Favors N-acetylcysteine Favors control
13th treatment shown to reduce risk in February 2021
*, now known with p = 0.000027 from 24 studies, recognized in 3 countries.
Lower risk for mortality, hospitalization, and cases.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,200+ studies for 70+ treatments.
Prospective study of 217 patients treated with NAC and 245 matched controls, showing improved recovery with treatment. 1500mg intravenous NAC daily.
risk of death, 29.4% lower, RR 0.71, p = 0.42, treatment 10 of 217 (4.6%), control 16 of 245 (6.5%), NNT 52.
risk of mechanical ventilation, 41.1% lower, RR 0.59, p = 0.16, treatment 12 of 217 (5.5%), control 23 of 245 (9.4%), NNT 26.
risk of ICU admission, 20.1% lower, RR 0.80, p = 0.36, treatment 29 of 217 (13.4%), control 41 of 245 (16.7%), NNT 30.
hospitalization time, 13.6% lower, relative time 0.86, p = 0.002, treatment 217, control 245.
relative ΔSpO2, 57.1% better, RR 0.43, treatment 217, control 245, relative improvement in SpO2, day 10.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Afaghi et al., 1 Jun 2023, prospective, Iran, peer-reviewed, 10 authors, study period 1 June, 2020 - 13 March, 2021, average treatment delay 6.0 days.
This PaperN-acetylcys..All
N-acetylcysteine as adjuvant therapy for hospitalized Covid-19 patients: A single-center prospective cohort study
MD Siamak Afaghi, MD Negin Moghimi, Nasser Malekpour, MD Fatemeh Sadat Rahimi, MD Rana Irilouzadian, MD, MPH Farzad Esmaeili Tarki, PhD Morvarid Moghimi, MD Sara Besharat, Hossein Salehi, MD Anita Karimi
Background: Whilst over two years have passed since the COVID-19 pandemic's emergence, the proper management of the disease remains challenging. Nacetylcysteine (NAC) as a potentially effective therapeutic option has been suggested by studies, while the exact clinical role of this agent is yet to be evaluated. Methods: This prospective case-control study was conducted in a major referral respiratory center in Tehran, Iran. We enrolled 217 patients treated with an intravenous daily dose of 1500 mg NAC as a case group; and 245 control patients who did not receive NAC. Two groups were matched based on other treatments, sociodemographics, medical history, and comorbidities. Results: After ten days of adjuvant therapy with NAC, patients in the NAC group and control group had median room-air SpO2 of 91% and 88%, respectively (P=0.02). Also, the SpO2 to FiO2 ratio had a median of 463 and 421 in the case and control groups, respectively (P=0.01). Furthermore, the case group's hospitalization period was three days shorter (P=0.002). Further, cough, dyspnea, and decreased appetite were reported to have a significantly lower incidence in the case group (P=0.03, 0.001, 0.008). Conclusion: We showed that a daily intravenous dose of NAC in hospitalized COVID-19 patients could shorten the hospital stay and improve some clinical symptoms; however, it does not remarkably improve the risk of ICU admission and the 28 days inhospital mortality rate.
Conflict of Interests
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Late treatment
is less effective
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