https://doi.org/10.55788/a086f1d0
N-acetylcysteine is an established mucolytic and anti-oxidant medicine for acute and chronic respiratory conditions [1]. In severely ill patients, intravenous administration of this agent may be the preferred route. However, no large-scale trials have studied the efficacy of intravenous N-acetylcysteine as a mucolytic and expectorant therapy.
To address this gap in the literature, Prof. Alberto Papi (University of Ferrara, Italy) and co-investigators randomised 333 patients with acute respiratory conditions and abnormal mucus secretion 1:1:1 to standard-of-care plus a 7-day course of intravenous N-acetylcysteine (600 mg, twice daily), standard-of-care plus intravenous ambroxol hydrochloride (30 mg, twice daily), or standard-of-care plus placebo. Prof. Papi presented the results of the primary endpoints, which were the change from baseline to day 7 in mean sputum viscosity score and expectoration difficulty score, comparing the N-acetylcysteine arm with the placebo arm [2]. The primary endpoints were measured at 4-point ordinal scales.
The sputum viscosity score had improved significantly more in the N-acetylcysteine arm than in the placebo arm (-1.2 vs -1.0; P<0.001). Similarly, the expectoration difficulty score had dropped with 1.4 points in the N-acetylcysteine arm and with 1.1 points in the placebo arm, significantly favouring the experimental arm (P=0.002). Prof. Papi added that the observed safety profile was in line with the good tolerability of intravenous N-acetylcysteine (600 mg, twice daily) that had been reported in previous smaller studies [3].
“This is the first, large, randomised-controlled trial to demonstrate clinical benefits of intravenous N-acetylcysteine in patients with respiratory diseases and abnormal mucus secretion,” decided Prof. Papi.
- Sadowska AM, et al. Int J Chron Obstruct Pulmon Dis. 2006; 1(4): 425–434.
- Papi A, et al. Randomized, rater-blinded, controlled study of intravenous (IV) Nacetylcysteine (NAC) in hospitalized adults with respiratory tract disease and abnormal mucus secretion. ALERT 1, RCT714, ERS International Congress 2022, Barcelona, Spain, 4–6 September.
- Calverley P, et al. Drug Saf. 2021;44(3):273–290.
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Table of Contents: ERS 2022
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