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0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Altay (DB RCT) 80% 0.20 [0.01-4.85] hosp. 0/229 1/76 CT​1 Improvement, RR [CI] Treatment Control Ignatova 20% 0.80 [0.64-1.00] hosp. time 56 (n) 55 (n) Tau​2 = 0.00, I​2 = 0.0%, p = 0.043 Early treatment 21% 0.79 [0.63-0.99] 0/285 1/131 21% improvement de Alencar (DB RCT) -3% 1.03 [0.41-2.27] death 9/67 9/68 Improvement, RR [CI] Treatment Control Gaynitdinova (RCT) 15% 0.85 [0.77-0.93] hosp. time 24 (n) 22 (n) Pellegrini 52% 0.48 [0.33-0.70] death 138 (n) 726 (n) Pourhoseingholi 11% 0.89 [0.68-1.18] death 65/309 274/2,159 Taher (DB RCT) 18% 0.82 [0.43-1.58] death 12/47 14/45 Assimakopoulos 97% 0.03 [0.00-0.30] death 2/42 12/40 Avdeev 69% 0.31 [0.03-2.72] death 1/24 3/22 Faverio (PSW) -19% 1.19 [0.85-1.66] death 91/572 44/329 Ramadhan -135% 2.35 [0.33-16.9] death 11/75 1/16 Izquierdo 26% 0.74 [0.63-0.88] death 136/2,071 1,935/17,137 Delić (RCT) 10% 0.90 [0.63-1.30] death 21/39 31/52 Intubated patients Fariña-González 39% 0.61 [0.34-1.09] death 10/38 44/102 Intubated patients Mousapour (DB RCT) 2% 0.98 [0.26-3.64] death 4/42 4/41 Çavuş (ICU) -13% 1.13 [0.85-1.50] death 52/97 44/93 ICU patients Tau​2 = 0.06, I​2 = 70.2%, p = 0.02 Late treatment 20% 0.80 [0.67-0.97] 414/3,585 2,415/20,852 20% improvement Huh 26% 0.74 [0.68-0.80] cases population-based cohort Improvement, RR [CI] Treatment Control Tau​2 = 0.00, I​2 = 0.0%, p < 0.0001 Prophylaxis 26% 0.74 [0.68-0.80] 26% improvement All studies 20% 0.80 [0.70-0.91] 414/3,870 2,416/20,983 20% improvement 17 N-acetylcysteine COVID-19 studies c19early.org/na Dec 2022 Tau​2 = 0.03, I​2 = 67.7%, p = 0.001 Effect extraction pre-specified(most serious outcome) 1 CT: study uses combined treatment Favors N-acetylcysteine Favors control
N-acetylcysteine COVID-19 studies. Recent:
Çavuş
La Maestra
Mousapour
Fariña-González.
Submit updates/corrections.
Oct 25
Çavuş et al., Aksaray Üniversitesi Tıp Bilimleri Dergisi, 3:2 Kritik COVID-19 hastalarında kullanılan N-asetilsisteinin(NAC) klinik bulgulara, inflamatuar parametrelere böbrek fonksiyonlarına olan etkileri
13% higher mortality [p=0.47], 20% higher ventilation [p=0.25], 12% shorter ICU admission [p=0.58], and 13% shorter hospitalization [p=0.09]. Retrospective 190 critical COVID-19 patients in Turkey, showing no significant differences with N-acetylcysteine treatment in unadjusted results with no baseline details. NAC 2400mg/day.
Oct 21
La Maestra et al., Cells, doi:10.3390/cells11203313 (In Vitro) Inhibition of the Cell Uptake of Delta and Omicron SARS-CoV-2 Pseudoviruses by N-Acetylcysteine Irrespective of the Oxidoreductive Environment
ACE2-HEK293 In Vitro study showing dose-dependent inhibition of the uptake of delta and omicron SARS-CoV-2 pseudoviruses with N-acetylcysteine.
Jun 20
Mousapour et al., Gastroenterology and Hepatology from Bed to Bench, doi:10.22037/ghfbb.v15i3.2565 Efficacy and Safety of Acetylcysteine for the Prevention of Liver Injury in Covid-19 Intensive Care Unit Patients Under Treatment with Remdesivir: A Double-Blind, Placebo-Controlled Randomized Clinical Trial: Prevention of liver injury in severe Covid-19 pneumonia
2% lower mortality [p=1], 27% lower ventilation [p=0.57], 6% better improvement [p=0.82], and 5% higher hospital discharge [p=0.8]. RCT 83 severe COVID-19 pnuemonia patients in Iran, 42 treated with acetylcysteine, showing no significant difference in clinical outcomes. All patients received remdesivir, famotidine, and vitamin C. More patients were at baseline categor..
May 31
Fariña-González et al., Journal of Intensive Care Medicine, doi:10.1177/08850666221105423 Hourly Analysis of Mechanical Ventilation Parameters in Critically Ill Adult Covid-19 Patients: Association with Mortality
39% lower mortality [p=0.08]. Retrospective 140 mechanically ventilated patients in Spain, showing lower mortality with acetylcysteine treatment in unadjusted results, not reaching statistical significance.
May 28
Delić et al., Microorganisms, doi:10.3390/microorganisms10061118 Effects of Different Inhalation Therapy on Ventilator-Associated Pneumonia in Ventilated COVID-19 Patients: A Randomized Controlled Trial
10% lower mortality [p=0.67]. RCT mechanically ventilated patients in Croatia, 39 treated with N-acetylcysteine and 52 control patients, showing no significant difference in mortality with treatment. Treated patients showed a lower incidence of gram-positive or MRSA-c..
Jan 27
Izquierdo et al., Science Progress, doi:10.1177/00368504221074574 Use of N-Acetylcysteine at high doses as an oral treatment for patients hospitalized with COVID-19
26% lower mortality [p=0.0007]. Retrospective 19,208 COVID+ hospitalized patients in Spain, 2,071 treated with high dose NAC, showing lower mortality with treatment. In multivariable analysis, authors adjust for corticosteroids, but do not adjust for HCQ use which was a..
Jan 21
Goc et al., European Journal of Microbiology and Immunology, doi:10.1556/1886.2021.00022 (In Vitro) Inhibitory effects of specific combination of natural compounds against SARS-CoV-2 and its Alpha, Beta, Gamma, Delta, Kappa, and Mu variants
In Vitro study testing combinations of plant extracts and micronutrients with several variants of SARS-CoV-2. A combination of vitamin C, N-acetylcysteine, curcumin, quercetin, resveratrol, theaflavin, naringenin, baicalin, and broccoli e..
Dec 27
2021
Ramadhan et al., Indonesian Journal of Tropical and Infectious Disease, 9:3 The Effects of N-Acetylcysteine as Adjuvant Therapy To Reduce TNF-Α Level And Increase SPO2/FIO2 Ratio In Improving Hypoxemia In COVID-19 Patients
135% higher mortality [p=0.68]. Prospective study with 75 NAC patients and 16 control patients, showing no significant difference in mortality.
Dec 2
2021
Faverio et al., ERJ Open Research, doi:10.1183/23120541.00542-2021 Impact of N-acetyl-l-cysteine on SARS-CoV-2 pneumonia and its sequelae: results from a large cohort study
19% higher mortality [p=0.33], 34% higher ICU admission [p=0.08], and 1% higher hospital discharge [p=0.94]. Retrospective 1,083 consecutive hospitalized COVID patients in Italy, showing no significant differences with NAC treatment. The number of patients transferred to another facility exceeds the number of deaths, which may significantly affe..
Nov 10
2021
Ignatova et al., Russian Medical Inquiry, doi:10.32364/2587-6821-2021-5-7-473-478 Therapeutic possibilities of using an expectorant mucolytic agent with antioxidant properties in COVID-19 infection
20% shorter hospitalization [p=0.05]. Retrospective 111 patients with moderate COVID-19 pneumonia, 56 treated with NAC, showing shorter hospitalization time with treatment. NAC 1200mg daily intravenous, divided into two doses.
Jul 9
2021
Avdeev et al., Journal of Infection, doi:10.1016/j.jinf.2021.07.003 N-acetylcysteine for the treatment of COVID-19 among hospitalized patients
69% lower mortality [p=0.34], 77% lower ventilation [p=0.18], 77% lower ICU admission [p=0.18], and 15% shorter hospitalization [p=0.01]. Prospective study of 24 hospitalized COVID-19 patients in Russia treated with NAC, and 22 matched controls, showing significantly improved SpO2/FiO2, and significantly shorter hospitalization with treatment.
Jun 29
2021
Assimakopoulos et al., Infectious Diseases, doi:10.1080/23744235.2021.1945675 N-acetyl-cysteine reduces the risk for mechanical ventilation and mortality in patients with COVID-19 pneumonia: a two-center retrospective cohort study
97% lower mortality [p=0.006]. Retrospective 42 hospitalized PCR+ COVID-19 pneumonia patients treated with NAC, and a matched control group of 40 patients, showing significantly lower severe respiratory failure and significantly lower mortality with treatment. NAC 600 ..
Jun 28
2021
Altay et al., Advanced Science, doi:10.1002/advs.202101222 Combined Metabolic Activators Accelerates Recovery in Mild-to-Moderate COVID-19
80% lower hospitalization [p=0.25] and 83% improved recovery [p<0.0001]. RCT 304 low-risk outpatients, 229 treated with N-acetylcysteine, l-carnitine tartrate, nicotinamide riboside chloride, and serine, showing significantly faster recovery with treatment. Plasma levels of proteins and metabolites associated ..
Jun 10
2021
Taher et al., Pharmacological Reports, doi:10.1007/s43440-021-00296-2 A pilot study on intravenous N-Acetylcysteine treatment in patients with mild-to-moderate COVID19-associated acute respiratory distress syndrome
18% lower mortality [p=0.65], 14% lower ventilation [p=0.67], 20% shorter ICU admission [p=0.48], and 33% shorter hospitalization [p=0.31]. RCT 92 hospitalized patients, 47 treated with NAC, showing non-significant improvements in outcomes. IRCT20120215009014N355. NAC 40mg/kg/day intravenous for 3 days.
May 26
2021
Pourhoseingholi et al., Research Square, doi:10.21203/rs.3.rs-365321/v2 (Preprint) Case Characteristics, Clinical Data, And Outcomes of Hospitalized COVID-19 Patients In Qom Province, Iran: A Prospective Cohort Study
11% lower mortality [p=0.43]. Prospective study of 2,468 hospitalized COVID-19 patients in Iran, showing no significant difference with NAC treatment. IR.MUQ.REC.1399.013.
May 23
2021
Pellegrini et al., Gastroenterology, doi:10.1016/S0016-5085(21)02756-6 A Retrospective Analysis of Outcomes Amongst COVID-19 Infected Patients with Acute Hepatitis Receiving N-Acetylcysteine Therapy in a Safety Net Hospital
52% lower mortality [p=0.0001]. Retrospective 864 hospitalized late stage COVID-19 patients in the USA, 138 receiving NAC treatment for acute hepatitis, showing lower mortality with treatment. Results are adjusted for confounders, however details are not provided.
Feb 19
2021
Gaynitdinova et al., Pulmonologiya, doi:10.18093/0869-0189-2021-31-1-21-29 N-acetylcysteine as a part of complex treatment of moderate COVID-associated pneumonia
15% shorter hospitalization [p=0.001] and 51% improved recovery [p=0.001]. RCT 46 hospitalized patients with moderate COVID-19 pneumonia, 24 treated wth N-acetylcysteine, showing significantly shorter hospitalization with treatment. NAC 1,200 – 1,500mg/day intravenously.
Sep 23
2020
de Alencar et al., Clinical Infectious Diseases, doi:10.1093/cid/ciaa1443 Double-blind, Randomized, Placebo-controlled Trial With N-acetylcysteine for Treatment of Severe Acute Respiratory Syndrome Caused by Coronavirus Disease 2019 (COVID-19)
3% higher mortality [p=0.94], 16% higher ventilation [p=0.64], 9% lower ICU admission [p=0.65], and 10% longer hospitalization [p=0.87]. RCT 135 severe stage patients in Brazil, showing no significant differences. NAC 21g (~300mg/kg) for 20 hours. U1111-1250-356 [ensaiosclinicos.gov.br].
May 4
2020
Huh et al., medRxiv, doi:10.1101/2020.05.04.20089904 (Preprint) Association of previous medications with the risk of COVID-19: a nationwide claims-based study from South Korea
26% fewer cases [p<0.0001]. Retrospective database analysis of 65,149 in South Korea, showing significantly lower cases with existing N-acetylcysteine treatment. The journal version of this paper does not present the N-acetylcysteine results.
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