Impact of N-Acetylcysteine on Modulating Inflammation in Patients Hospitalized with Moderate COVID-19 Infections: A Prospective Randomized Trial

Sherkawy, Sara M; Elwakeel, Lamia M.; Schaalan, Mona F.; Moharram, Ayman N.; Abouelwafa, Mohamed Ahmed

doi:10.21608/aps.2023.212265.1122

Impact of N-Acetylcysteine on Modulating Inflammation in Patients Hospitalized with Moderate COVID-19 Infections: A Prospective Randomized Trial

Document Type : Original Article

Authors

¹ Department of Clinical Pharmacy, Faculty of Pharmacy, Misr International University, Cairo, Egypt.

² Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo 11566, Egypt.

³ Department of Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.

10.21608/aps.2023.212265.1122

Abstract

Background. N- acetylcysteine (NAC) is a widely used safe mucolytic, that demonstrated positive impacts on various respiratory diseases via its anti-inflammatory and antioxidant effects. The study aimed to evaluate potential benefit of adding high dose oral N- acetylcysteine in hospitalized moderate-severity COVID-19 patients.
Methodology. A prospective, single- center, randomized clinical trial on 60 hospitalized moderate COVID-19 patients who were randomly assigned to NAC group (30); received NAC daily at 1800 mg added to institutional protocol, or non-NAC group (30); received only the institutional protocol. Outcomes. Primary outcome was the change in plasma TNF-α, IL-6 and glutathione peroxidase level. Secondary outcomes were the length of hospital stay, need for oxygen support, duration on oxygenation and mortality rate between the two study groups.
Results. At study-end, a significant decline in TNF-α levels (p< 0.001) and a significant increase in glutathione peroxidase in the NAC treated group (p=0.001) was evident. Groups were comparable in IL-6 levels (p=0.810). The duration on oxygen support significantly decreased in NAC group (p=0.005). On the contrary, hospital stay length and oxygen support need was not affected by addition of NAC (p- values, 0.45, 0.42, respectively). Mortality rate was comparable in both groups.
Conclusion. Addition of 1800 mg of NAC to institutional treatment protocol for moderate COVID-19 patients have led to a decline in the levels of plasma TNF-α and increased glutathione peroxidase levels. Moreover, duration required on oxygen support decreased in patients needing supplemental oxygenation.

Keywords