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Meta-Analysis
. 2023 Mar 1;86(3):274-281.
doi: 10.1097/JCMA.0000000000000869. Epub 2023 Jan 9.

Is N -acetylcysteine effective in treating patients with coronavirus disease 2019? A meta-analysis

Chih-Hao Chen  1 , Kai-Feng Hung  2   3 , Chii-Yuan Huang  1   4 , Jing-Li Leong  5 , Yuan-Chia Chu  6   7   8 , Chun-Yu Chang  9 , Mong-Lien Wang  2   9   10   11 , Shih-Hwa Chiou  2   10 , Yen-Fu Cheng  1   2   4   12
Affiliations
Meta-Analysis

Is N -acetylcysteine effective in treating patients with coronavirus disease 2019? A meta-analysis

Chih-Hao Chen et al. J Chin Med Assoc. .

Abstract

Background: Coronavirus disease 2019 (COVID-19) is a global pandemic caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). It has brought tremendous challenges to public health and medical systems around the world. The current strategy for drug repurposing has accumulated some evidence on the use of N -acetylcysteine (NAC) in treating patients with COVID-19. However, the evidence remains debated.

Methods: We performed the systematic review and meta-analysis that complies with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five databases and reference lists were searched from inception to May 14, 2022. Studies evaluating the efficacy of NAC in treating patients with COVID-19 were regarded as eligible. The review was registered prospectively on PROSPERO (CRD42022332791).

Results: Of 778 records identified from the preliminary search, four studies were enrolled in the final qualitative review and quantitative meta-analysis. A total of 355 patients were allocated into the NAC group and the control group. The evaluated outcomes included intubation rate, improvement, duration of intensive unit stay and hospital stay and mortality. The pooled results showed nonsignificant differences in intubation rate (OR, 0.55; 95% CI, 0.16-1.89; p = 0.34; I2 = 75%), improvement of oxygenation ([MD], 80.84; 95% CI, -38.16 to 199.84; p = 0.18; I2 = 98%), ICU stay (MD, -0.74; 95% CI, -3.19 to 1.71; p = 0.55; I2 = 95%), hospital stay (MD, -1.05; 95% CI, -3.02 to 0.92; p = 0.30; I2 = 90%), and mortality (OR, 0.58; 95% CI, 0.23-1.45; p = 0.24; I2 = 54%). Subsequent trial sequential analysis (TSA) showed conclusive nonsignificant results for mortality, while the TSA for the other outcomes suggested that a larger sample size is essential.

Conclusions: The current evidence reveals NAC is not beneficial for treating patients with COVID- 19 with regard to respiratory outcome, mortality, duration of ICU stay and hospital stay.

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Conflict of interest statement

Conflicts of interest: Dr. Shih-Hwa Chiou, an editorial board member at Journal of the Chinese Medical Association, had no role in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.

References

    1. Ciotti M, Ciccozzi M, Terrinoni A, Jiang WC, Wang CB, Bernardini S. The Covid-19 pandemic. Crit Rev Clin Lab Sci 2020;57:365–88.
    1. Dong E, Du H, Gardner L. An interactive web-based dashboard to track Covid-19 in real time. Lancet Infect Dis 2020;20:533–4.
    1. Moghadas SM, Vilches TN, Zhang K, Wells CR, Shoukat A, Singer BH, et al. The impact of vaccination on coronavirus disease 2019 (Covid-19) outbreaks in the United States. Clin Infect Dis 2021;73:2257–64.
    1. Tenforde MW, Self WH, Adams K, Gaglani M, Ginde AA, McNeal T, et al. Association between mRNA vaccination and Covid-19 hospitalization and disease severity. JAMA 2021;326:2043–54.
    1. Saravolatz LD, Depcinski S, Sharma M. Molnupiravir and nirmatrelvir-ritonavir: oral Covid antiviral drugs. Clin Infect Dis 2023;76:165–71.

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