Synopsis

Source of validity: Scientific
Rating (out of 5): 2

N-Acetylcysteine (NAC), not "L-Acetyl n-Cysteine," is a well-studied compound used primarily as a mucolytic agent and antioxidant. Its use in fibrosis, particularly pulmonary fibrosis (such as idiopathic pulmonary fibrosis, IPF), is based on its role as a precursor to glutathione, a major cellular antioxidant. Oxidative stress is thought to contribute to the pathogenesis of fibrosis, and by replenishing glutathione levels, NAC may reduce oxidative damage and slow disease progression.

Scientific evidence for NAC in fibrosis is mixed. Some early studies and small clinical trials suggested potential benefits in slowing the decline of lung function in IPF patients, particularly when used as an adjunct to standard therapy. However, larger randomized controlled trials, such as the PANTHER-IPF study (NEJM, 2014), failed to demonstrate a significant benefit of NAC monotherapy in improving clinical outcomes compared to placebo in IPF patients. Recent guidelines from major respiratory societies now recommend against the routine use of NAC for IPF, due to insufficient evidence of clinical efficacy.

For other forms of fibrosis (such as liver fibrosis), evidence is even less robust, with mainly preclinical or animal studies suggesting potential antifibrotic effects. Overall, while there is a scientific rationale for NAC in addressing oxidative stress in fibrotic diseases, its clinical benefit remains unproven, and current evidence does not robustly support its use for treating fibrosis.

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