N-acetylcysteine as a part of complex treatment of moderate COVID-associated pneumonia
Viliya V Gaynitdinova, Sergey N Avdeev, Zamira M Merzhoeva, Null- M Berikkhanov, Inna V Medvedeva, T L Gorbacheva
PULMONOLOGIYA, doi:10.18093/0869-0189-2021-31-1-21-29
The need for safe and effective treatment is becoming increasingly urgent due to the high COVID-19 mortality rates observed worldwide. The choice of drug products for COVID-19 treatment regimens is based on the efficacy and safety data, the mechanism of action, and potential interactions. N-acetylcysteine's (NAC) pharmacological activity and its potential to suppress the progression of COVID-19 make it a promising therapeutic agent for COVID-19. Aim of the study was to evaluate the efficacy of NAC in the complex treatment of moderate COVID-associated pneumonia. Methods. The study included adult patients (n = 46) with moderate COVID-associated (the 2 nd -3 rd degree on CT) pneumonia (age 57 (51; 71) years, body mass index -30 (27.1; 32.3) kg/m 2 , duration of the disease before hospitalization -7 (6; 8) days, body temperature at the admission -37.5 (37.1; 37.8) °С). The patients were randomized into two study groups. The 1 st group (n = 22) received standard COVID-19 treatment [1]. The 2 nd group (n = 24) additionally received NAC 1,200 -1,500 mg/day intravenously. Treatment with NAC was started together with the standard therapy. Results. Our study showed that the inclusion of NAC in the complex treatment of moderate COVID-associated pneumonia led to a statistically significant increase in blood oxygen saturation, oxygenation index, the difference in delta increase in oxygenation index, a quicker reduction in the volume of lung damage, and the difference between the groups in delta reduction of this index. Also, the rate of reduction of C-reactive protein and reduction of the duration of hospitalization in the group of patients who received NAC was statistically significantly more profound than in the standard treatment group.
Conclusion. The study confirmed the effectiveness of NAC as a part of the complex treatment of moderate COVID-associated pneumonia.
References
Abaturov, Volosovets, Borysova, Drug management of oxidation-reduction state of the body in respiratory tract diseases (part 2
Adhikari, Burns, Meade, Pharmacologic therapies for adults with acute lung injury and acute respiratory distress syndrome, Cochrane Database Syst. Rev,
doi:10.1002/14651858.CD004477.pub2Adhikari, Burns, Meade, Pharmacologic therapies for adults with acute lung injury and acute respiratory distress syndrome, Cochrane Database Syst. Rev,
doi:10.1002/14651858.CD004477.pub2Atmosfera, Pul'monologiya i allergologiya
Avdeev, Batyn, Merzhoeva, Chuchalin, High doses of N-acetylcysteine in acute respiratory distress syndrome
Avdeev, Effect of prolonged N-acetylcysteine administration on COPD exacerbation rates
Bernard, Lucht, Niedermeyer, Effect of N-acetylcysteine on the pulmonary response to endotoxin in the awake sheep and upon in vitro granulocyte function, J. Clin. Invest,
doi:10.1172/JCI111386Bernard, Lucht, Niedermeyer, Effect of N-acetylcysteine on the pulmonary response to endotoxin in the awake sheep and upon in vitro granulocyte function, J. Clin. Invest,
doi:10.1172/JCI111386Cao, Zhang, Wang, Clinical features of patients infected with the 2019 novel coronavirus (COVID-19)
Cascella, Rajnik, Cuomo, Features, evaluation, and treatment of coronavirus (COVID-19
Cascella, Rajnik, Cuomo, Features, evaluation, and treatment of coronavirus (COVID-19
Conti, Ronconi, Caraffa, Induction of pro-inflammatory cytokines (IL-1 and IL-6) and lung inflammation by Coronavirus-19 (COVI-19 or SARS-CoV-2): anti-inflammatory strategies, J. Biol. Regul. Homeost. Agents,
doi:10.23812/CONTI-EConti, Ronconi, Caraffa, Induction of pro-inflammatory cytokines (IL-1 and IL-6) and lung inflammation by Coronavirus-19 (COVI-19 or SARS-CoV-2): anti-inflammatory strategies, J. Biol. Regul. Homeost. Agents,
doi:10.23812/CONTI-EDavreux, Soric, Nathens, N-acetyl cysteine attenuates acute lung injury in the rat, Shock
Davreux, Soric, Nathens, N-acetyl cysteine attenuates acute lung injury in the rat, Shock
De Alencar, Moreira, Müller, Double-blind, randomized, placebo-controlled trial with N-acetylcysteine for treatment of severe acute respiratory syndrome caused by Coronavirus Disease 2019 (COVID-19), Clin. Infect. Dis,
doi:10.1093/cid/ciaa1443De Alencar, Moreira, Müller, Double-blind, randomized, placebo-controlled trial with N-acetylcysteine for treatment of severe acute respiratory syndrome caused by Coronavirus Disease 2019 (COVID-19), Clin. Infect. Dis,
doi:10.1093/cid/ciaa1443.Поступила12.03.20Gaynitdinova, N-acetylcysteine as a part of complex treatment of moderately severe COVID-associated pneumonia
Guglielmetti, Quaglia, Sainaghi, War to the knife" against thromboinflammation to protect endothelial function of COVID-19 patients, Crit. Care,
doi:10.1186/s13054-020-03060-9Guglielmetti, Quaglia, Sainaghi, War to the knife" against thromboinflammation to protect endothelial function of COVID-19 patients, Crit. Care,
doi:10.1186/s13054-020-03060-9Ibrahim, Perl, Smith, Therapeutic blockade of inflammation in severe COVID-19 infection with intravenous N-acetylcysteine, Clin. Immunol,
doi:10.1016/j.clim.2020.108544Ibrahim, Perl, Smith, Therapeutic blockade of inflammation in severe COVID-19 infection with intravenous N-acetylcysteine, Clin. Immunol,
doi:10.1016/j.clim.2020.108544Island, Stat-Pearls Publishing
Island, Stat-Pearls Publishing
Kelly, Clinical application of N acetylcysteine, Altern. Med. Rev
Kelly, Clinical application of N acetylcysteine, Altern. Med. Rev
Olsson, Johansson, Gabrielsson, Bolme, Pharmacokinetics and bioavailability of reduced and oxidized N-acetylcysteine, Eur. J. Clin. Pharmacol,
doi:10.1007/BF01061422Olsson, Johansson, Gabrielsson, Bolme, Pharmacokinetics and bioavailability of reduced and oxidized N-acetylcysteine, Eur. J. Clin. Pharmacol,
doi:10.1007/BF01061422Pandharipande, Shintani, Hagerman, Derivation and validation of SpO 2 /FiO 2 ratio to impute for PaO 2 /FiO 2 ratio in the respiratory component of the Sequential Organ Failure Assessment score, Crit. Care Med,
doi:10.1097/CCM.0b013e31819cefa9Pandharipande, Shintani, Hagerman, Derivation and validation of SpO 2 /FiO 2 ratio to impute for PaO 2 /FiO 2 ratio in the respiratory component of the Sequential Organ Failure Assessment score, Crit. Care Med,
doi:10.1097/CCM.0b013e31819cefa9Polonikov, Endogenous deficiency of glutathione as the most likely cause of serious manifestations and death in COVID-19 patients, ACS Infect. Dis,
doi:10.1021/acsinPolonikov, Endogenous deficiency of glutathione as the most likely cause of serious manifestations and death in COVID-19 patients, ACS Infect. Dis,
doi:10.1021/acsinSadowska, Manuel-Y-Keenoy, Backer, Antioxidant and anti-inflammatory efficacy of NAC in the treat-The article is licensed by CC BY-NC-ND 4.0 International Licensee, Pharmacol. Ther,
doi:10.1016/j.pupt.2005.12.007Sadowska, Manuel-Y-Keenoy, Backer, Antioxidant and anti-inflammatory efficacy of NAC in the treatment of COPD: discordant in vitro and in vivo dose-effects: A review, Pulm. Pharmacol. Ther,
doi:10.1016/j.pupt.2005.12.007Todd, Luzina, Atamas, Molecular and cellular mechanisms of pulmonary fibrosis, Fibrogenesis Tissue Repair,
doi:10.1186/1755-1536-5-11Todd, Luzina, Atamas, Molecular and cellular mechanisms of pulmonary fibrosis, Fibrogenesis Tissue Repair,
doi:10.1186/1755-1536-5-11Zafarullah, Li, Sylvester, Ahmad, Molecular mechanisms of N-acetylcysteine actions, Cell. Mol. Life Sci,
doi:10.1007/s000180300001Zafarullah, Li, Sylvester, Ahmad, Molecular mechanisms of N-acetylcysteine actions, Cell. Mol. Life Sci,
doi:10.1007/s000180300001Zhang, Ju, Ma, Wang, N-acetylcysteine improves oxidative stress and inflammatory response in patients with community acquired pneumonia: A randomized controlled trial, Medicine,
doi:10.1097/MD.0000000000013087Zhang, Ju, Ma, Wang, N-acetylcysteine improves oxidative stress and inflammatory response in patients with community acquired pneumonia: A randomized controlled trial, Medicine,
doi:10.1097/MD.0000000000013087Абатуров, Волосовец, Борисова, П. Медикаментозное управление окислительно-восстановительным состоянием организма при заболеваниях органов дыхания (часть 2), Здоровье ребенка,
doi:10.22141/2224-0551.13.3.2018.132918Авдеев, Батын, Мержоева, Чучалин, .Г. Высокие дозы N-ацетилцистеина при остром респираторном дистресс-синдроме, Пульмонология
Авдеев, Влияние длительного приема N-ацетилцистеина на частоту обострений ХОБЛ. Атмосфера. Пульмонология, и аллергология
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