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The role of N-acetylcysteine in decreasing neutrophil-lymphocyte ratio in COVID-19 patients: A double-blind, randomized controlled trial

Prabowo et al., Narra J, doi:10.52225/narra.v3i2.121, NCT05658549
May 2023  
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13th treatment shown to reduce risk in February 2021
*, now known with p = 0.000034 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.
4,000+ studies for 60+ treatments.
RCT 40 moderate/severe COVID-19 patients in Indonesia, showing significantly lower NLR with N-acetylcysteine treatment.
Prabowo et al., 19 May 2023, Double Blind Randomized Controlled Trial, placebo-controlled, Indonesia, peer-reviewed, mean age 44.7, 3 authors, trial NCT05658549 (history). Contact:
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P R O F E S S I O N A L T A G L I N E, Nurhasan A Prabowo, Marcelino A Megantara, Hendrastutik Apriningsih, Prabowo Na Megantara
N-acetylcysteine has antioxidant and anti-inflammatory activities that could potentially improve the clinical outcomes of coronavirus disease 2019 (COVID-19) patients. Nacetylcysteine potentially inhibits NLRP3 (NOD-, LRR-and pyrin domain-containing protein 3) inflammasome and results in control oxidative stress and cytokine release in COVID-19 patients. The aim of this study was to assess the effect of N-acetylcysteine in reducing the neutrophil-lymphocyte ratio (NLR) in COVID-19 patients. A randomized controlled clinical trial was conducted among severe and moderate COVID-19 patients. The treatment group received oral 1200 mg daily of N-acetylcysteine (three times a day) and the standard care for COVID-19, while the control group received standard care for COVID-19 and a placebo. The NLR was determined on the first day of admission and after the seventh day of treatment. A paired Student t-test was used to compare the NLR before and after treatment while independent Student t-test was used to compare the NLR between treatment and control groups. A total of 40 severe and moderate COVID-19 were enrolled, 20 people in each group, with a mean age was 44.68±13.24 years old. The mean NLR on the first day was 9.44 in the treatment group and 8.84 in the control group. After the seventh day, the mean NLR was 4.27 and 11.54 in the treatment group and control group, respectively. The mean changes of NLR (the pre-treatment compared to posttreatment) in the treatment and control group were reduced 4.05 and increased 3.34, respectively. The NLR in treatment group significantly decreased compared to the control group (p<0.001). In conclusion, N-acetylcysteine 1200 mg daily could reduce the NLR in severe and moderate COVID-19 patients.
Ethics approval The Health Research Ethics Committee of Dr. Moewardi Hospital Surakarta has approved this research by approval Number: 149/II/HREC/2021. All participants provided informed consent before the study started. Conflict of interest The authors declare that they have no competing interests. Underlying data Derived data supporting the findings of this study are available from the corresponding author on request.
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Late treatment
is less effective
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