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Is N -acetylcysteine effective in treating patients with coronavirus disease 2019? A meta-analysis
Chih-Hao Chen1, Kai-Feng Hung2,3, Chii-Yuan Huang1,4
1Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
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.
Insights
N-acetylcysteine (NAC) does not show significant benefits for treating COVID-19 patients. This systematic review found no improvements in respiratory outcomes, mortality, or hospital/ICU stays for those receiving NAC.
Area of Science:
- Medical Research
- Pulmonology
- Infectious Diseases
Background:
- Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, presents global health challenges.
- N-acetylcysteine (NAC) has been investigated for repurposing in COVID-19 treatment, but evidence remains debated.
Approach:
- A systematic review and meta-analysis adhering to PRISMA guidelines was conducted.
- Searched five databases up to May 14, 2022, including studies on NAC efficacy in COVID-19 patients.
- Registered prospectively on PROSPERO (CRD42022332791).
Key Points:
- Four studies with 355 patients were analyzed.
- No significant differences were found in intubation rates, oxygenation improvement, ICU/hospital stay duration, or mortality.
- Trial sequential analysis indicated conclusive nonsignificant results for mortality, but suggested larger sample sizes for other outcomes.
Conclusions:
- Current evidence indicates N-acetylcysteine (NAC) offers no benefit for COVID-19 patients.
- NAC did not improve respiratory outcomes, reduce mortality, or shorten ICU/hospital stays.
