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

Author:

Chen Chih-Hao1,Hung Kai-Feng23,Huang Chii-Yuan14,Leong Jing-Li5,Chu Yuan-Chia678,Chang Chun-Yu9,Wang Mong-Lien291011,Chiou Shih-Hwa210,Cheng Yen-Fu12412

Affiliation:

1. Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

2. Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

3. Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC

4. Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC

5. Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

6. Information Management Office, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

7. Medical AI Development Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

8. Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC

9. Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, ROC

10. Institute of Pharmacology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC

11. Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC

12. Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC

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; I 2 = 75%), improvement of oxygenation ([MD], 80.84; 95% CI, -38.16 to 199.84; p = 0.18; I 2 = 98%), ICU stay (MD, -0.74; 95% CI, -3.19 to 1.71; p = 0.55; I 2 = 95%), hospital stay (MD, -1.05; 95% CI, -3.02 to 0.92; p = 0.30; I 2 = 90%), and mortality (OR, 0.58; 95% CI, 0.23-1.45; p = 0.24; I 2 = 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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

General Medicine

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