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. 2023 Nov;11(11):e1083.
doi: 10.1002/iid3.1083.

Evaluation of the efficacy and safety of oral N-acetylcysteine in patients with COVID-19 receiving the routine antiviral and hydroxychloroquine protocol: A randomized controlled clinical trial

Najmolsadat Atefi  1 , Azadeh Goodarzi  1 , Taghi Riahi  2 , Niloofar Khodabandehloo  3 , Mahshid Talebi Taher  4 , Niloufar Najar Nobari  1 , Farnoosh Seirafianpour  5 , Zeinab Mahdi  1 , Amir Baghestani  6 , Rohollah Valizadeh  7
Affiliations

Evaluation of the efficacy and safety of oral N-acetylcysteine in patients with COVID-19 receiving the routine antiviral and hydroxychloroquine protocol: A randomized controlled clinical trial

Najmolsadat Atefi et al. Immun Inflamm Dis. 2023 Nov.

Abstract

Background: The current absence of gold-standard or all-aspect favorable therapies for COVID-19 renders a focus on multipotential drugs proposed to prevent or treat this infection or ameliorate its signs and symptoms vitally important. The present well-designed randomized controlled trial (RCT) sought to evaluate the efficacy and safety of N-acetylcysteine (NAC) as adjuvant therapy for 60 hospitalized Iranian patients with COVID-19.

Methods: Two 30-person diets, comprising 15 single diets of Kaletra (lopinavir/ritonavir) + hydroxychloroquine (HCQ) with/without NAC (600 mg TDS) and atazanavir/ritonavir + HCQ with/without NAC (600 mg TDS), were administered in the study.

Results: At the end of the study, a further decrease in C-reactive protein was observed in the NAC group (P = 0.008), and no death occurred in the atazanavir/ritonavir + HCQ + NAC group, showing that the combination of these drugs may reduce mortality. The atazanavir/ritonavir + HCQ and atazanavir/ritonavir + NAC groups exhibited the highest O2 saturation at the end of the study and a significant rise in O2 saturation following intervention commencement, including NAC (P > 0.05). Accordingly, oral or intravenous NAC, if indicated, may enhance O2 saturation, blunt the inflammation trend (by reducing C-reactive protein), and lower mortality in hospitalized patients with COVID-19.

Conclusion: The NAC could be more effective as prophylactic or adjuvant therapy in stable non-severe cases of COVID-19 with a particularly positive role in the augmentation of O2 saturation and faster reduction of the CRP level and inflammation or could be effective for better controlling of COVID-19 or its therapy-related side effects.

Keywords: COVID-19; Kaletra; N-acetylcysteine; NAC; antiviral; atazanavir; hydroxychloroquine; lopinavir; ritonavir.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The flow diagram shows the flow of patients through the trial.
Figure 2
Figure 2
The image illustrates a comparison of opacification consolidation between the study groups according to the drugs administered.
See this image and copyright information in PMC

References

    1. Jorge‐Aarón R‐M, Rosa‐Ester M‐P. N‐acetylcysteine as a potential treatment for COVID‐19. Future Med. 2020;15:959‐969. - PMC - PubMed
    1. Chan JFW, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person‐to‐person transmission: a study of a family cluster. Lancet. 2020;395(10223):514‐523. - PMC - PubMed
    1. Jayaweera M, Perera H, Gunawardana B, Manatunge J. Transmission of COVID‐19 virus by droplets and aerosols: a critical review on the unresolved dichotomy. Environ Res. 2020;188:109819. 10.1016/j.envres.2020.109819 - DOI - PMC - PubMed
    1. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID‐19 infection? Respir Med. 2020;8(4):e21. - PMC - PubMed
    1. Bhat SA, Singh G, Bhat WF, Borole K, Khan AA. Coronavirus disease‐2019 and its current scenario—a review. Clinical eHealth. 2021;4:67‐73. 10.1016/j.ceh.2021.09.002 - DOI

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