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Early |
Ignatova et al., Russian Medical Inquiry, doi:10.32364/2587-6821-2021-5-7-473-478 (Peer Reviewed) |
hosp. time, ↓20.3%, p<0.05 |
Therapeutic possibilities of using an expectorant mucolytic agent with antioxidant properties in COVID-19 infection |
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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. |
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Early treatment study
Early treatment study
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| Therapeutic possibilities of using an expectorant mucolytic agent with antioxidant properties in COVID-19 infection |
| Ignatova et al., Russian Medical Inquiry, doi:10.32364/2587-6821-2021-5-7-473-478 (Peer Reviewed) |
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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.
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hospitalization time, 20.3% lower, relative time 0.80, p < 0.05, treatment 56, control 55.
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Ignatova et al., 11/10/2021, retrospective, Russia, Europe, peer-reviewed, median age 49.2, 12 authors, average treatment delay 4.6 days.
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Late |
Avdeev et al., Journal of Infection, doi:10.1016/j.jinf.2021.07.003 (Peer Reviewed) |
death, ↓69.4%, p=0.34 |
N-acetylcysteine for the treatment of COVID-19 among hospitalized patients |
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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. |
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Late treatment study
Late treatment study
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| N-acetylcysteine for the treatment of COVID-19 among hospitalized patients |
| Avdeev et al., Journal of Infection, doi:10.1016/j.jinf.2021.07.003 (Peer Reviewed) |
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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.
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risk of death, 69.4% lower, RR 0.31, p = 0.34, treatment 1 of 24 (4.2%), control 3 of 22 (13.6%), NNT 11.
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risk of mechanical ventilation, 77.1% lower, RR 0.23, p = 0.18, treatment 1 of 24 (4.2%), control 4 of 22 (18.2%), NNT 7.1.
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risk of ICU admission, 77.1% lower, RR 0.23, p = 0.18, treatment 1 of 24 (4.2%), control 4 of 22 (18.2%), NNT 7.1.
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hospitalization time, 15.4% lower, relative time 0.85, p = 0.01, treatment 24, control 22.
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Avdeev et al., 7/9/2021, retrospective, Russia, Europe, peer-reviewed, 4 authors, study period 12 April, 2020 - 20 June, 2020, average treatment delay 7.2 days.
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Late |
Assimakopoulos et al., Infectious Diseases, doi:10.1080/23744235.2021.1945675 (Peer Reviewed) |
death, ↓97.1%, p=0.006 |
N-acetyl-cysteine reduces the risk for mechanical ventilation and mortality in patients with COVID-19 pneumonia: a two-center retrospective cohort study |
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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 .. |
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Late treatment study
Late treatment study
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| N-acetyl-cysteine reduces the risk for mechanical ventilation and mortality in patients with COVID-19 pneumonia: a two-center retrospective cohort study |
| Assimakopoulos et al., Infectious Diseases, doi:10.1080/23744235.2021.1945675 (Peer Reviewed) |
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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 mg bid orally for 14 days.
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risk of death, 97.1% lower, RR 0.03, p = 0.006, treatment 2 of 42 (4.8%), control 12 of 40 (30.0%), NNT 4.0, OR converted to RR.
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Assimakopoulos et al., 6/29/2021, retrospective, Greece, Europe, peer-reviewed, 9 authors, study period 1 February, 2021 - 30 April, 2021.
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Early |
Altay et al., Advanced Science, doi:10.1002/advs.202101222 (Peer Reviewed) |
hosp., ↓80.1%, p=0.25 |
Combined Metabolic Activators Accelerates Recovery in Mild-to-Moderate COVID-19 |
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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 .. |
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Early treatment study
Early treatment study
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| Combined Metabolic Activators Accelerates Recovery in Mild-to-Moderate COVID-19 |
| Altay et al., Advanced Science, doi:10.1002/advs.202101222 (Peer Reviewed) |
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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 with inflammation and antioxidant metabolism were significantly improved in treated patients.
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risk of hospitalization, 80.1% lower, RR 0.20, p = 0.25, treatment 0 of 229 (0.0%), control 1 of 76 (1.3%), NNT 76, relative risk is not 0 because of continuity correction due to zero events.
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risk of no recovery, 82.7% lower, RR 0.17, p < 0.001, treatment 229, control 75, multivariate Cox regression.
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Altay et al., 6/28/2021, Double Blind Randomized Controlled Trial, placebo-controlled, Turkey, Europe, peer-reviewed, 18 authors, this trial uses multiple treatments in the treatment arm (combined with l-carnitine tartrate, nicotinamide riboside chloride, serine) - results of individual treatments may vary.
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Late |
Taher et al., Pharmacological Reports, doi:10.1007/s43440-021-00296-2 (Peer Reviewed) |
death, ↓17.9%, p=0.65 |
A pilot study on intravenous N-Acetylcysteine treatment in patients with mild-to-moderate COVID19-associated acute respiratory distress syndrome |
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RCT 92 hospitalized patients, 47 treated with NAC, showing non-significant improvements in outcomes. IRCT20120215009014N355. NAC 40mg/kg/day intravenous for 3 days. |
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Late treatment study
Late treatment study
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| A pilot study on intravenous N-Acetylcysteine treatment in patients with mild-to-moderate COVID19-associated acute respiratory distress syndrome |
| Taher et al., Pharmacological Reports, doi:10.1007/s43440-021-00296-2 (Peer Reviewed) |
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RCT 92 hospitalized patients, 47 treated with NAC, showing non-significant improvements in outcomes. IRCT20120215009014N355. NAC 40mg/kg/day intravenous for 3 days.
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risk of death, 17.9% lower, RR 0.82, p = 0.65, treatment 12 of 47 (25.5%), control 14 of 45 (31.1%), NNT 18.
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risk of mechanical ventilation, 13.8% lower, RR 0.86, p = 0.67, treatment 18 of 47 (38.3%), control 20 of 45 (44.4%), NNT 16.
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ICU time, 20.0% lower, relative time 0.80, p = 0.48, treatment 47, control 45.
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hospitalization time, 33.3% lower, relative time 0.67, p = 0.31, treatment 47, control 45.
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risk of no recovery, 14.5% lower, RR 0.85, p = 0.41, treatment 25 of 47 (53.2%), control 28 of 45 (62.2%), NNT 11.
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Taher et al., 6/10/2021, Double Blind Randomized Controlled Trial, Iran, Middle East, peer-reviewed, 6 authors, average treatment delay 7.0 days.
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Late |
Gaynitdinova et al., Pulmonologiya, doi:10.18093/0869-0189-2021-31-1-21-29 (Peer Reviewed) |
hosp. time, ↓15.4%, p<0.001 |
N-acetylcysteine as a part of complex treatment of moderate COVID-associated pneumonia |
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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. |
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Late treatment study
Late treatment study
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| N-acetylcysteine as a part of complex treatment of moderate COVID-associated pneumonia |
| Gaynitdinova et al., Pulmonologiya, doi:10.18093/0869-0189-2021-31-1-21-29 (Peer Reviewed) |
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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.
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hospitalization time, 15.4% lower, relative time 0.85, p < 0.001, treatment 24, control 22.
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relative improvement in lung Ct, 50.7% better, RR 0.49, p < 0.001, treatment 24, control 22.
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Gaynitdinova et al., 2/19/2021, Randomized Controlled Trial, Russia, Europe, peer-reviewed, 6 authors, average treatment delay 7.0 days.
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Late |
de Alencar et al., Clinical Infectious Diseases, doi:10.1093/cid/ciaa1443 (Peer Reviewed) |
death, ↑2.6%, p=0.94 |
Double-blind, Randomized, Placebo-controlled Trial With N-acetylcysteine for Treatment of Severe Acute Respiratory Syndrome Caused by Coronavirus Disease 2019 (COVID-19) |
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RCT 135 severe stage patients in Brazil, showing no significant differences. NAC 21g (~300mg/kg) for 20 hours. U1111-1250-356 [1]. |
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Late treatment study
Late treatment study
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| Double-blind, Randomized, Placebo-controlled Trial With N-acetylcysteine for Treatment of Severe Acute Respiratory Syndrome Caused by Coronavirus Disease 2019 (COVID-19) |
| de Alencar et al., Clinical Infectious Diseases, doi:10.1093/cid/ciaa1443 (Peer Reviewed) |
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RCT 135 severe stage patients in Brazil, showing no significant differences. NAC 21g (~300mg/kg) for 20 hours. U1111-1250-356 [1].
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risk of death, 2.6% higher, RR 1.03, p = 0.94, treatment 9 of 67 (13.4%), control 9 of 68 (13.2%), OR converted to RR.
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risk of mechanical ventilation, 16.0% higher, RR 1.16, p = 0.64, treatment 16 of 67 (23.9%), control 14 of 68 (20.6%), OR converted to RR.
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risk of ICU admission, 8.5% lower, RR 0.91, p = 0.65, treatment 29 of 67 (43.3%), control 32 of 68 (47.1%), NNT 26, OR converted to RR.
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ICU time, 12.5% higher, relative time 1.12, p = 0.56, treatment 67, control 68.
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hospitalization time, 10.0% higher, relative time 1.10, p = 0.87, treatment 67, control 68.
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de Alencar et al., 9/23/2020, Double Blind Randomized Controlled Trial, placebo-controlled, Brazil, South America, peer-reviewed, median age 59.0, 65 authors, average treatment delay 7.0 days.
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PrEPPEP |
Huh et al., medRxiv, doi:10.1101/2020.05.04.20089904 (Preprint) |
cases, ↓26.2%, p<0.0001 |
Association of previous medications with the risk of COVID-19: a nationwide claims-based study from South Korea |
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Retrospective database analysis of 65,149 in South Korea, showing significantly lower cases with existing N-acetylcysteine treatment. |
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Prophylaxis study
Prophylaxis study
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| Association of previous medications with the risk of COVID-19: a nationwide claims-based study from South Korea |
| Huh et al., medRxiv, doi:10.1101/2020.05.04.20089904 (Preprint) |
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Retrospective database analysis of 65,149 in South Korea, showing significantly lower cases with existing N-acetylcysteine treatment.
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risk of case, 26.2% lower, RR 0.74, p < 0.001, treatment 710 of 13,788 (5.1%), control 4,462 of 51,361 (8.7%), NNT 28, adjusted, OR converted to RR, multivariable.
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Huh et al., 5/4/2020, retrospective, database analysis, South Korea, Asia, preprint, 10 authors.
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