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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 Tau​2 = 0.06, I​2 = 73.5%, p = 0.019 Late treatment 22% 0.78 [0.63-0.96] 348/3,408 2,323/20,616 22% 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 22% 0.78 [0.68-0.90] 348/3,693 2,324/20,747 22% improvement 14 N-acetylcysteine COVID-19 studies Aug 2022 Tau​2 = 0.03, I​2 = 69.3%, p = 0.00056 Effect extraction pre-specified(most serious outcome) 1 CT: study uses combined treatment Favors N-acetylcysteine Favors control
N-acetylcysteine COVID-19 studies. Recent:
Submit updates/corrections.
May 28
Late Delić et al., Microorganisms, doi:10.3390/microorganisms10061118
death, ↓9.7%, p=0.67
Effects of Different Inhalation Therapy on Ventilator-Associated Pneumonia in Ventilated COVID-19 Patients: A Randomized Controlled Trial
Details   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
Late Izquierdo et al., Science Progress, doi:10.1177/00368504221074574
death, ↓25.6%, p=0.0007
Use of N-Acetylcysteine at high doses as an oral treatment for patients hospitalized with COVID-19
Details   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
In Vitro Goc et al., European Journal of Microbiology and Immunology, doi:10.1556/1886.2021.00022 (In Vitro)
In Vitro
Inhibitory effects of specific combination of natural compounds against SARS-CoV-2 and its Alpha, Beta, Gamma, Delta, Kappa, and Mu variants
Details   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
Late Ramadhan et al., Indonesian Journal of Tropical and Infectious Disease, 9:3
death, ↑134.7%, p=0.68
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
Details   Prospective study with 75 NAC patients and 16 control patients, showing no significant difference in mortality.
Dec 2
Late Faverio et al., ERJ Open Research, doi:10.1183/23120541.00542-2021
death, ↑19.0%, p=0.33
Impact of N-acetyl-l-cysteine on SARS-CoV-2 pneumonia and its sequelae: results from a large cohort study
Details   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
Early Ignatova et al., Russian Medical Inquiry, doi:10.32364/2587-6821-2021-5-7-473-478
hosp. time, ↓20.3%, p<0.05
Therapeutic possibilities of using an expectorant mucolytic agent with antioxidant properties in COVID-19 infection
Details   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
Late Avdeev et al., Journal of Infection, doi:10.1016/j.jinf.2021.07.003
death, ↓69.4%, p=0.34
N-acetylcysteine for the treatment of COVID-19 among hospitalized patients
Details   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
Late Assimakopoulos et al., Infectious Diseases, doi:10.1080/23744235.2021.1945675
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
Details   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
Early Altay et al., Advanced Science, doi:10.1002/advs.202101222
hosp., ↓80.1%, p=0.25
Combined Metabolic Activators Accelerates Recovery in Mild-to-Moderate COVID-19
Details   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
Late Taher et al., Pharmacological Reports, doi:10.1007/s43440-021-00296-2
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
Details   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
Late Pourhoseingholi et al., Research Square, doi:10.21203/ (Preprint)
death, ↓11.0%, p=0.43
Case Characteristics, Clinical Data, And Outcomes of Hospitalized COVID-19 Patients In Qom Province, Iran: A Prospective Cohort Study
Details   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
Late Pellegrini et al., Gastroenterology, doi:10.1016/S0016-5085(21)02756-6
death, ↓51.7%, p=0.0001
A Retrospective Analysis of Outcomes Amongst COVID-19 Infected Patients with Acute Hepatitis Receiving N-Acetylcysteine Therapy in a Safety Net Hospital
Details   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
Late Gaynitdinova et al., Pulmonologiya, doi:10.18093/0869-0189-2021-31-1-21-29
hosp. time, ↓15.4%, p<0.001
N-acetylcysteine as a part of complex treatment of moderate COVID-associated pneumonia
Details   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
Late de Alencar et al., Clinical Infectious Diseases, doi:10.1093/cid/ciaa1443
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)
Details   RCT 135 severe stage patients in Brazil, showing no significant differences. NAC 21g (~300mg/kg) for 20 hours. U1111-1250-356 .
May 4
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
Details   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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