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Intravenous N-Acetylcysteine in Management of COVID-19: A Case Series
Brandon Chen1, Karan Raja1, Frantz Pierre-Louis2
1Pharmacy Department, Clara Maass Medical Center, Belleville, NJ, USA.
Insights
N-acetylcysteine (NAC) did not show benefits in reducing the cytokine storm in COVID-19 patients. This study found that NAC administration did not improve patient outcomes, indicating further research is needed for effective treatments.
Area of Science:
- Virology
- Immunology
- Pharmacology
Background:
- Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes COVID-19, leading to potentially fatal cytokine storms.
- Cytokine storms involve elevated inflammatory markers like interleukin-6 (IL-6) and nuclear factor-kappaB (NF-kappaB).
- N-acetylcysteine (NAC) may modulate NF-kappaB activation by replenishing glutathione, potentially mitigating cytokine storms.
Purpose of the Study:
- To investigate the efficacy of intravenous N-acetylcysteine (NAC) in attenuating the cytokine storm in COVID-19 patients.
- To assess the impact of NAC on clinical outcomes using the World Health Organization (WHO) symptom severity scale.
Main Methods:
- A retrospective case series of 10 patients with confirmed COVID-19 who received intravenous NAC.
- Patient outcomes were monitored and graded using the WHO symptom severity scale (0-8).
Main Results:
- The median WHO Scale score was 6.5 prior to NAC administration.
- By day seven, the median WHO Scale score increased, indicating clinical worsening in patients.
- The study found no significant benefit of NAC in attenuating the cytokine storm or improving patient outcomes.
Conclusions:
- Intravenous NAC administration did not demonstrate clinical benefit in this cohort of COVID-19 patients.
- Further research is warranted to explore alternative drug regimens or therapeutic strategies for managing COVID-19 cytokine storms.
Abstract:
A novel coronavirus, severe acute respiratory syndrome coronavirus-2, was isolated from patients' lower respiratory tracts in December 2019. As of May 19, 2021, there were over 33 million reported infections and almost 600,000 deaths in the United States. The infection, coronavirus disease-19 (COVID-19), can lead to cytokine storm, with elevations in interleukin-6 (IL-6), IL-10, tumor necrosis factor-α, nuclear factor-kappaB (NF-kappaB), and glutathione reductase. NF-kappaB activation is necessary for further transcription of other pro-inflammatory markers. Glutathione may play a role in modulation of NF-kappaB activation and elevated glutathione reductase may indicate glutathione depletion. Administration of N-acetylcysteine (NAC) may replenish spent glutathione and attenuate over-activation of NF-kappaB. This retrospective case series included 10 patients who were COVID-19 positive and received intravenous NAC in an attempt to attenuate the cytokine storm. Patients' outcomes were graded based on the World Health Organization symptom severity scale from 0, no evidence of infection, to 8, death. Overall, the median WHO Scale prior to NAC was 6.5, and increased by day seven, which indicated clinical worsening. This retrospective case series showed no benefit of NAC; however, further studies are needed to elucidate if differences in drug regimens would lead to positive results.
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