Evaluating N-acetylcysteine for early and end-of-treatment abstinence in adult cigarette smokers.

Abstract

BACKGROUND\nThere is robust preclinical literature and preliminary clinical findings supporting the use of N-Acetylcysteine (NAC) to treat substance use disorders, including tobacco use disorder (TUD). However, randomized controlled trials have yielded mixed results and NAC s efficacy for TUD has not been established. The goals of this study were to assess the efficacy of NAC in promoting early and end-of-treatment abstinence and preventing relapse among adult smokers.\n\n\nMETHODS\nThis randomized, double-blinded clinical trial enrolled adult, daily smokers (N\u2009=\u2009114; ages 23-64; 51 % female; 65 % White; 29 % Black/African American; 7% Hispanic/Latinx), who were randomized 1:1 to receive NAC (n\u2009=\u200959) or placebo (n\u2009=\u200955) (1200\u2009mg b.i.d.) for eight weeks. Participants received brief cessation counseling and incentives for abstinence during the first three days of the quit attempt. Primary outcomes: (i) carbon monoxide (CO)-confirmed abstinence during the first three days of the quit attempt.\n\n\nSECONDARY OUTCOMES\n(ii) time to relapse; (iii) biologically confirmed abstinence at Week 8.\n\n\nRESULTS\nNo differences were found between NAC and placebo groups on measures of early abstinence (3-day quit attempt; 11 % for NAC vs. 15 % for placebo; all p\u2009>\u20090.11), time to relapse (p\u2009=\u20090.19), and end-of-treatment abstinence (7% for NAC vs. 11 % for placebo; all p\u2009>\u20090.40].\n\n\nCONCLUSIONS\nResults indicate that NAC is a well-tolerated pharmacotherapy but is unlikely to be efficacious as a monotherapy for TUD in adults. Considered in the collective context of other research, NAC may potentially be more useful in a younger population, as a combination pharmacotherapy, or in the presence of more intensive psychosocial treatment.