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CompletedNCT03843541Updated Sep 5, 2025Results posted

A Clinical Trial to Compare the Efficacy and Safety of 1-week Treatment of Intravenous N-acetylcysteine (NAC) 600 mg Twice Daily, Ambroxol Hydrochloride 30 mg Twice Daily and Placebo as Expectorant Therapies in Adult Chinese Patients With Respiratory Tract Diseases and Abnormal Mucus Secretions

A Phase 3 interventional study of N-acetylcysteine (NAC) 600 mg and Ambroxol hydrochloride 30 mg in Respiratory Tract Diseases and Abnormal Mucus Secretions, sponsored by Zambon SpA. Completed at 32 sites in China. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-09-05.

Sponsored by Zambon SpA · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
333
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

This is a phase 3, multicenter, randomized, rater- and patient-blind, placebo- and active-controlled, 3-arm parallel group clinical trial. Patients will be randomized to N-acetylcysteine (NAC) or ambroxol or placebo in a 1:1:1 ratio. A total of approximately 333 patients in China will be randomized. The total study duration will be approximately 8 months including the enrolment period of approximately 7 months and the patient participation duration of 1 month or 4 weeks. Each patient will undergo a screening period of up to 1 week, a 1-week treatment period and a 2-week follow-up period. This study will be conducted in approximately 15-25 sites in China.

02

Conditions studied

  • Respiratory Tract Diseases
  • Abnormal Mucus Secretions

Keywords

  • N-acetylcysteine (NAC)
  • ambroxol hydrochloride
  • bronchitis
  • cystic fibrosis
  • fibrosis bronchiectasis
  • increased sputum viscosity
  • cough
  • Chronic Obstructive Pulmonary Disease (COPD)
03

In context

Respiratory Tract Diseases

410 studies on the registry are indexed under Respiratory Tract Diseases; 59 are open to participants now.

This study's enrollment of 333 is above the median of 117 across 316 interventional studies indexed under Respiratory Tract Diseases.

Browse Respiratory Tract Diseases studies →

Lead sponsor

Zambon SpA is the lead sponsor of 23 studies on the registry; none are open to participants now.

Of its 5 completed or terminated interventional studies of FDA-regulated products, 4 (80%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  1. Male or female adult (≥18 years old) hospitalized patients with respiratory tract diseases and abnormal mucus secretions such as: acute bronchitis, chronic bronchitis and exacerbations, emphysema, mucoviscidosis and bronchiectasis.
  2. Chinese ethnicity and/or Chinese
  3. Signed the form before any study-related procedure
  4. Sputum viscosity score ≥ 2 at randomization visit
  5. Expectoration difficulty score ≥ 2 at randomization visit
  6. Willingness and ability to comply with study procedures

Exclusion criteria

Exclusion Criteria:

  1. Intolerance or to treatment with NAC or ambroxol or allergy to any component of the study treatments
  2. (For female patients) ongoing pregnancy or lactation, or but unwillingness to adopt abstinence or measures during the study
  3. Intake of an drug within 1 month before the screening visit
  4. Use of expectorants or drugs with expectorant effect within 2 days before randomization visit
  5. Diagnosis of active tuberculosis, lung cancer, pulmonary fibrosis, acute pulmonary thromboembolism or any other respiratory condition that might, in the opinion of the investigator, compromise the safety of the patient or affect the interpretation of the results
  6. Medical history of and/or illness (including laboratory abnormality) and/or treatment that in the investigator's opinion may interfere with the patient's safety, compliance, or study evaluations
  7. Serum and/or aspartate transaminase more than 3 times above the at screening visit
  8. Serum creatinine more than 3 times above the upper limit of normal at screening visit
  9. Addiction to alcohol or drugs
  10. Mental illness, or other reasons for non-cooperation in the investigator's opinion
Terms in these criteria, in plain language(7)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Contraindication

A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.

Childbearing potential

Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).

Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

05

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Double (Participant, Outcomes assessor)
Enrollment
333 participants (actual)

Study arms

  • Experimental
    Active test treatment-NAC

    NAC 600mg will be administered by slow intravenous infusion twice daily for the 1-week treatment period.

    Drug: N-acetylcysteine (NAC) 600 mg

  • Active comparator
    Active control treatment-Ambroxol hydrochloride

    Ambroxol hydrochloride 30 mg will be administered by slow intravenous infusion twice daily for the 1-week treatment period.

    Drug: Ambroxol hydrochloride 30 mg

  • Placebo comparator
    Placebo

    Placebo will be administered by slow intravenous infusion twice daily for the 1-week treatment period.

    Other: placebo

Interventions

  • NAC will be administered twice a day, morning and evening, during treatment period.

    Also known as: Fluimucil®

  • Ambroxol hydrochloride will be administered twice a day, morning and evening, during treatment period.

    Also known as: Mucosolvan®, Fluibron®

  • Otherplacebo

    Placebo will be administered twice a day, morning and evening, during treatment period.

06

What researchers measure

Primary outcomes

  1. Change From Baseline to Day 7 of Mean Sputum Viscosity Score of NAC and Placebo

    The superiority of slow intravenous infusion of NAC to placebo in terms of change from baseline in sputum viscosity score was demonstrated. Sputum viscosity was assessed by ordinal categorical 4-point scales \[0 = Liquid (normal viscosity), 1= Fluid (mildly increased viscosity), 2 = Viscous (moderately increased viscosity), 3 = Sticky (severely increased viscosity)\] with 0 = best and 3= worst.

    Time frame: From baseline upto Day 7

  2. Change From Baseline to Day 7 Treatment of Mean Expectoration Difficulty Score of NAC and Placebo

    The superiority of slow intravenous infusion of NAC 600 mg twice daily to placebo in terms of change from baseline in expectoration difficulty score was demonstrated. Expectoration difficulty was assessed by ordinal categorical 4-point scales \[0 = No difficulty, 1 = Mild difficulty, 2 = Moderate difficulty, 3 = Marked difficulty\] with 0 = best and 3 = worst.

    Time frame: From Baseline upto Day 7

Secondary outcomes

  1. Change From Baseline to Day 3 in Mean Sputum Viscosity Score of NAC and Placebo

    The superiority of slow intravenous infusion of NAC to placebo in terms of change from baseline in sputum viscosity score was demonstrated. Sputum viscosity was assessed by ordinal categorical 4-point scales \[0 = Liquid (normal viscosity), 1= Fluid (mildly increased viscosity), 2 = Viscous (moderately increased viscosity), 3 = Sticky (severely increased viscosity)\] with 0 = best and 3= worst.

    Time frame: From Baseline to Day 3

  2. Change From Baseline to Day 3 in Mean Expectoration Difficulty Score of NAC and Placebo

    The superiority of slow intravenous infusion of NAC to placebo in terms of change from baseline in expectoration difficulty score was demonstrated. Expectoration difficulty was assessed by ordinal categorical 4-point scales \[0 = No difficulty, 1 = Mild difficulty, 2 = Moderate difficulty, 3 = Marked difficulty\] with 0 = best and 3 = worst.

    Time frame: From Baseline to Day 3

  3. Change From Baseline to Day 3 and to Day 7 in Mean Sputum Color Score of NAC and Placebo

    The superiority of the slow intravenous infusion of NAC to placebo in terms of change from baseline in sputum color score was demonstrated. Sputum color was assessed by means of ordinal categorical 4-point scales \[0 = Mostly white, 1= Mostly pale yellow, 2 = Mostly dark yellow, 3 = Very dark yellow /green\] with 0 = best and 3= worst.

    Time frame: From Baseline upto Day 3 and Day 7

  4. Change From Baseline to Day 3 and to Day 7 in Mean Cough Severity Score of NAC and Placebo

    The superiority of the slow intravenous infusion of NAC to placebo in terms of change from baseline in cough score was demonstrated. Cough score was assessed by means of ordinal categorical 4-point scales \[0 = No cough, 1= Sporadic and mild cough, 2 = Moderate cough, 3 = Severe Cough\] with 0 = best and 3= worst.

    Time frame: From Baseline upto Day 3 and Day 7

  5. Change From Baseline to Day 3 and to Day 7 of Mean Sputum Volume of NAC and Placebo

    The superiority of the slow intravenous infusion of NAC to placebo in terms of change from baseline in sputum volume was demonstrated. Patients collected 24-hour sputum (morning to same time of the following morning) in a graduated cup and volume was expressed as mL/24h.

    Time frame: From Baseline upto Day 3 and Day 7

  6. Change From Baseline to Day 7 in Mean Sputum Viscosity Score of NAC and Ambroxol Hydrochloride

    The non-inferiority of NAC versus ambroxol in terms of change from baseline to Day 7 of mean sputum viscosity score was demonstrated. Sputum viscosity was assessed by ordinal categorical 4-point scales \[0 = Liquid (normal viscosity), 1= Fluid (mildly increased viscosity), 2 = Viscous (moderately increased viscosity), 3 = Sticky (severely increased viscosity)\] with 0 = best and 3= worst.

    Time frame: From baseline upto Day 7

  7. Change From Baseline to Day 7 in Mean Expectoration Difficulty Score of NAC and Ambroxol Hydrochloride

    The non-inferiority of NAC versus ambroxol in terms of change from baseline to Day 7 of mean expectoration difficulty score was demonstrated. Expectoration difficulty was assessed by ordinal categorical 4-point scales \[0 = No difficulty, 1 = Mild difficulty, 2 = Moderate difficulty, 3 = Marked difficulty\] with 0 = best and 3= worst

    Time frame: From Baseline upto Day 7

  8. Change From Baseline to Day 3 and to Day 7 in Mean Sputum Viscosity Score of Ambroxol Hydrochloride and Placebo

    The superiority of the slow intravenous infusion ambroxol hydrochloride to placebo in terms of change from baseline in sputum viscosity score was demonstrated. Sputum viscosity was assessed by ordinal categorical 4-point scales \[0 = Liquid (normal viscosity), 1= Fluid (mildly increased viscosity), 2 = Viscous (moderately increased viscosity), 3 = Sticky (severely increased viscosity)\] with 0 = best and 3= worst.

    Time frame: From Baseline upto Day 3 and Day 7

  9. Change From Baseline to Day 3 and to Day 7 in Mean Expectoration Difficulty Score of Ambroxol Hydrochloride and Placebo

    The superiority of the slow intravenous infusion of ambroxol hydrochloride to placebo in terms of change from baseline in expectoration difficulty score was demonstrated. Expectoration difficulty was assessed by ordinal categorical 4-point scales \[0 = No difficulty, 1 = Mild difficulty, 2 = Moderate difficulty, 3 = Marked difficulty\] with 0 = best and 3 = worst.

    Time frame: From Baseline upto Day 3 and Day 7

  10. Change From Baseline to Day 3 and to Day 7 in Mean Sputum Color Score of Ambroxol Hydrochloride and Placebo

    The superiority of slow intravenous infusion of ambroxol hydrochloride to placebo in terms of change from baseline in sputum color was demonstrated. Sputum color was assessed by means of ordinal categorical 4-point scales \[0 = Mostly white, 1= Mostly pale yellow, 2 = Mostly dark yellow, 3 = Very dark yellow /green\] with 0 = best and 3= worst.

    Time frame: From Baseline upto Day 3 and Day 7

  11. Change From Baseline to Day 3 and to Day 7 in Mean Cough Severity Score of Ambroxol Hydrochloride and Placebo

    The superiority of slow intravenous infusion of ambroxol hydrochloride to placebo in terms of change from baseline in cough score was demonstrated. Cough score was assessed by means of ordinal categorical 4-point scales \[0 = No cough, 1= Sporadic and mild cough, 2 = Moderate cough, 3 = Severe Cough\] with 0 = best and 3= worst.

    Time frame: From Baseline upto Day 3 and Day 7

  12. Change From Baseline to Day 3 and to Day 7 in Mean Sputum Volume of Ambroxol Hydrochloride and Placebo

    The superiority of slow intravenous infusion of ambroxol hydrochloride to placebo in terms of change from baseline in mean sputum volume was demonstrated. Patients collected 24-hour sputum (morning to same time of the following morning) in a graduated cup and volume was expressed as mL/24h.

    Time frame: From Baseline upto Day 3 and Day 7

Other outcomes

  1. Number of Participants With Adverse Events

    The safety and tolerability of intravenous NAC 600 mg twice daily was demonstrated.

    Time frame: From screening to follow-up after the last administration of the investigational medicinal product (IMP) [assessed up to 19 months]

07

Results

Posted Jan 5, 2023

Participant flow

The study was conducted between 21-June-2019 and 5-February-2021 in 28 sites in China.

Participant flow — Overall Study
MilestoneN-AcetylcysteineAmbroxol HydrochloridePlacebo
Started111111111
Modified itt108110110
Completed969597
Not completed151614
Withdrew: Adverse event423
Withdrew: Death100
Withdrew: Lack of adherence to study medication001
Withdrew: Physician decision122
Withdrew: Study subject withdrawal by parent or guardian100
Withdrew: Withdrawal by subject697
Withdrew: Administration of rescue mucolytic001
Withdrew: Reporting drug over temperature, patients plan to transfer to hospital, and discharge from hospital.230

Outcome measures

PrimaryChange From Baseline to Day 7 of Mean Sputum Viscosity Score of NAC and Placebo

The superiority of slow intravenous infusion of NAC to placebo in terms of change from baseline in sputum viscosity score was demonstrated. Sputum viscosity was assessed by ordinal categorical 4-point scales \[0 = Liquid (normal viscosity), 1= Fluid (mildly increased viscosity), 2 = Viscous (moderately increased viscosity), 3 = Sticky (severely increased viscosity)\] with 0 = best and 3= worst.

Time frame:
From baseline upto Day 7
Reported as:
Mean · Score
Change From Baseline to Day 7 of Mean Sputum Viscosity Score of NAC and Placebo
ScoreN-AcetylcysteinePlacebo
Change From Baseline to Day 7 of Mean Sputum Viscosity Score of NAC and Placebo-1.2 ± 0.74-1.0 ± 0.78
Statistical analysis
  • N-Acetylcysteine vs Placebo · Wilcoxon (Mann-Whitney) · p = <0.001 · Mean difference (net): -0.24
PrimaryChange From Baseline to Day 7 Treatment of Mean Expectoration Difficulty Score of NAC and Placebo

The superiority of slow intravenous infusion of NAC 600 mg twice daily to placebo in terms of change from baseline in expectoration difficulty score was demonstrated. Expectoration difficulty was assessed by ordinal categorical 4-point scales \[0 = No difficulty, 1 = Mild difficulty, 2 = Moderate difficulty, 3 = Marked difficulty\] with 0 = best and 3 = worst.

Time frame:
From Baseline upto Day 7
Reported as:
Mean · Score
Change From Baseline to Day 7 Treatment of Mean Expectoration Difficulty Score of NAC and Placebo
ScoreN-AcetylcysteinePlacebo
Change From Baseline to Day 7 Treatment of Mean Expectoration Difficulty Score of NAC and Placebo-1.4 ± 0.78-1.1 ± 0.78
Statistical analysis
  • N-Acetylcysteine vs Placebo · Wilcoxon (Mann-Whitney) · p = 0.002 · Mean difference (net): -0.29
SecondaryChange From Baseline to Day 3 in Mean Sputum Viscosity Score of NAC and Placebo

The superiority of slow intravenous infusion of NAC to placebo in terms of change from baseline in sputum viscosity score was demonstrated. Sputum viscosity was assessed by ordinal categorical 4-point scales \[0 = Liquid (normal viscosity), 1= Fluid (mildly increased viscosity), 2 = Viscous (moderately increased viscosity), 3 = Sticky (severely increased viscosity)\] with 0 = best and 3= worst.

Time frame:
From Baseline to Day 3
Reported as:
Mean · Score
Change From Baseline to Day 3 in Mean Sputum Viscosity Score of NAC and Placebo
ScoreN-AcetylcysteinePlacebo
Change From Baseline to Day 3 in Mean Sputum Viscosity Score of NAC and Placebo-0.6 ± 0.59-0.6 ± 0.64
Statistical analysis
  • N-Acetylcysteine vs Placebo · Stratified Mann-Whitney U Statistic · p = 0.239
SecondaryChange From Baseline to Day 3 in Mean Expectoration Difficulty Score of NAC and Placebo

The superiority of slow intravenous infusion of NAC to placebo in terms of change from baseline in expectoration difficulty score was demonstrated. Expectoration difficulty was assessed by ordinal categorical 4-point scales \[0 = No difficulty, 1 = Mild difficulty, 2 = Moderate difficulty, 3 = Marked difficulty\] with 0 = best and 3 = worst.

Time frame:
From Baseline to Day 3
Reported as:
Mean · Score
Change From Baseline to Day 3 in Mean Expectoration Difficulty Score of NAC and Placebo
ScoreN-AcetylcysteinePlacebo
Change From Baseline to Day 3 in Mean Expectoration Difficulty Score of NAC and Placebo-0.8 ± 0.61-0.7 ± 0.64
Statistical analysis
  • N-Acetylcysteine vs Placebo · Stratified Mann-Whitney U Statistic · p = 0.037
SecondaryChange From Baseline to Day 3 and to Day 7 in Mean Sputum Color Score of NAC and Placebo

The superiority of the slow intravenous infusion of NAC to placebo in terms of change from baseline in sputum color score was demonstrated. Sputum color was assessed by means of ordinal categorical 4-point scales \[0 = Mostly white, 1= Mostly pale yellow, 2 = Mostly dark yellow, 3 = Very dark yellow /green\] with 0 = best and 3= worst.

Time frame:
From Baseline upto Day 3 and Day 7
Reported as:
Mean · Score
Change From Baseline to Day 3 and to Day 7 in Mean Sputum Color Score of NAC and Placebo
ScoreN-AcetylcysteinePlacebo
Change from baseline to Day 3-0.5 ± 0.72-0.5 ± 0.82
Change from baseline to Day 7-0.8 ± 0.89-0.8 ± 0.97
Statistical analysis
  • N-Acetylcysteine vs Placebo · Stratified Mann Whitney U Statistic · p = 0.093
  • N-Acetylcysteine vs Placebo · Stratified Mann Whitney U Statistic · p = 0.118
SecondaryChange From Baseline to Day 3 and to Day 7 in Mean Cough Severity Score of NAC and Placebo

The superiority of the slow intravenous infusion of NAC to placebo in terms of change from baseline in cough score was demonstrated. Cough score was assessed by means of ordinal categorical 4-point scales \[0 = No cough, 1= Sporadic and mild cough, 2 = Moderate cough, 3 = Severe Cough\] with 0 = best and 3= worst.

Time frame:
From Baseline upto Day 3 and Day 7
Reported as:
Mean · Score
Change From Baseline to Day 3 and to Day 7 in Mean Cough Severity Score of NAC and Placebo
ScoreN-AcetylcysteinePlacebo
Change from baseline to Day 3-0.4 ± 0.55-0.5 ± 0.60
Change from baseline to Day 7-0.8 ± 0.77-0.6 ± 0.72
Statistical analysis
  • N-Acetylcysteine vs Placebo · Stratified Mann Whitney U Statistic · p = 0.022
  • N-Acetylcysteine vs Placebo · Stratified Mann Whitney U Statistic · p = 0.110
SecondaryChange From Baseline to Day 3 and to Day 7 of Mean Sputum Volume of NAC and Placebo

The superiority of the slow intravenous infusion of NAC to placebo in terms of change from baseline in sputum volume was demonstrated. Patients collected 24-hour sputum (morning to same time of the following morning) in a graduated cup and volume was expressed as mL/24h.

Time frame:
From Baseline upto Day 3 and Day 7
Reported as:
Mean · mL/24h
Change From Baseline to Day 3 and to Day 7 of Mean Sputum Volume of NAC and Placebo
mL/24hN-AcetylcysteinePlacebo
Change from baseline to Day 3-1.601 ± 16.2611-4.144 ± 12.2348
Change from baseline to Day 7-9.405 ± 35.2191-7.391 ± 15.9992
Statistical analysis
  • N-Acetylcysteine vs Placebo · Stratified Mann Whitney U Statistic · p = 0.022
  • N-Acetylcysteine vs Placebo · Stratified Mann Whitney U Statistic · p = 0.402
SecondaryChange From Baseline to Day 7 in Mean Sputum Viscosity Score of NAC and Ambroxol Hydrochloride

The non-inferiority of NAC versus ambroxol in terms of change from baseline to Day 7 of mean sputum viscosity score was demonstrated. Sputum viscosity was assessed by ordinal categorical 4-point scales \[0 = Liquid (normal viscosity), 1= Fluid (mildly increased viscosity), 2 = Viscous (moderately increased viscosity), 3 = Sticky (severely increased viscosity)\] with 0 = best and 3= worst.

Time frame:
From baseline upto Day 7
Reported as:
Mean · Score
Change From Baseline to Day 7 in Mean Sputum Viscosity Score of NAC and Ambroxol Hydrochloride
ScoreN-AcetylcysteineAmbroxol Hydrochloride
Change From Baseline to Day 7 in Mean Sputum Viscosity Score of NAC and Ambroxol Hydrochloride-1.2 ± 0.74-1.2 ± 0.78
Statistical analysis
  • N-Acetylcysteine vs Ambroxol Hydrochloride · Modified Mann-Whitney U Statistic · p = 0.002 · Probability scale treatment difference: 0.50 · 97.5% CI 0.43 to 1.00The point estimates of treatment differences in probability scale together with associated one-side confidence interval (97.5% or 98.75%) were computed according to Hochberg if both superiority contrasts were found statistically significant.
SecondaryChange From Baseline to Day 7 in Mean Expectoration Difficulty Score of NAC and Ambroxol Hydrochloride

The non-inferiority of NAC versus ambroxol in terms of change from baseline to Day 7 of mean expectoration difficulty score was demonstrated. Expectoration difficulty was assessed by ordinal categorical 4-point scales \[0 = No difficulty, 1 = Mild difficulty, 2 = Moderate difficulty, 3 = Marked difficulty\] with 0 = best and 3= worst

Time frame:
From Baseline upto Day 7
Reported as:
Mean · Score
Change From Baseline to Day 7 in Mean Expectoration Difficulty Score of NAC and Ambroxol Hydrochloride
ScoreN-AcetylcysteineAmbroxol Hydrochloride
Change From Baseline to Day 7 in Mean Expectoration Difficulty Score of NAC and Ambroxol Hydrochloride-1.4 ± 0.78-1.3 ± 0.75
Statistical analysis
  • N-Acetylcysteine vs Ambroxol Hydrochloride · Modified Mann-Whitney U Statistic · p = <0.001 · Probability scale treatment difference: 0.5 · 98.75% CI 0.45 to 1.00The point estimates of treatment differences in probability scale together with associated one-side confidence interval (97.5% or 98.75%) were computed according to Hochberg if both superiority contrasts were found statistically significant. .
SecondaryChange From Baseline to Day 3 and to Day 7 in Mean Sputum Viscosity Score of Ambroxol Hydrochloride and Placebo

The superiority of the slow intravenous infusion ambroxol hydrochloride to placebo in terms of change from baseline in sputum viscosity score was demonstrated. Sputum viscosity was assessed by ordinal categorical 4-point scales \[0 = Liquid (normal viscosity), 1= Fluid (mildly increased viscosity), 2 = Viscous (moderately increased viscosity), 3 = Sticky (severely increased viscosity)\] with 0 = best and 3= worst.

Time frame:
From Baseline upto Day 3 and Day 7
Reported as:
Mean · Score
Change From Baseline to Day 3 and to Day 7 in Mean Sputum Viscosity Score of Ambroxol Hydrochloride and Placebo
ScoreAmbroxol HydrochloridePlacebo
Change from baseline to Day 3-0.6 ± 0.55-0.6 ± 0.64
Change from baseline to Day 7-1.2 ± 0.78-1.0 ± 0.78
Statistical analysis
  • Ambroxol Hydrochloride vs Placebo · Modified Mann-Whitney U Statistic · p = 0.356
  • Ambroxol Hydrochloride vs Placebo · Modified Mann-Whitney U Statistic · p = 0.007
SecondaryChange From Baseline to Day 3 and to Day 7 in Mean Expectoration Difficulty Score of Ambroxol Hydrochloride and Placebo

The superiority of the slow intravenous infusion of ambroxol hydrochloride to placebo in terms of change from baseline in expectoration difficulty score was demonstrated. Expectoration difficulty was assessed by ordinal categorical 4-point scales \[0 = No difficulty, 1 = Mild difficulty, 2 = Moderate difficulty, 3 = Marked difficulty\] with 0 = best and 3 = worst.

Time frame:
From Baseline upto Day 3 and Day 7
Reported as:
Mean · Score
Change From Baseline to Day 3 and to Day 7 in Mean Expectoration Difficulty Score of Ambroxol Hydrochloride and Placebo
ScoreAmbroxol HydrochloridePlacebo
Change from baseline to Day 3-0.7 ± 0.57-0.7 ± 0.64
Change from baseline to Day 7-1.3 ± 0.75-1.1 ± 0.78
Statistical analysis
  • Ambroxol Hydrochloride vs Placebo · Modified Mann-Whitney U Statistic · p = 0.380
  • Ambroxol Hydrochloride vs Placebo · Modified Mann-Whitney U Statistic · p = 0.018
SecondaryChange From Baseline to Day 3 and to Day 7 in Mean Sputum Color Score of Ambroxol Hydrochloride and Placebo

The superiority of slow intravenous infusion of ambroxol hydrochloride to placebo in terms of change from baseline in sputum color was demonstrated. Sputum color was assessed by means of ordinal categorical 4-point scales \[0 = Mostly white, 1= Mostly pale yellow, 2 = Mostly dark yellow, 3 = Very dark yellow /green\] with 0 = best and 3= worst.

Time frame:
From Baseline upto Day 3 and Day 7
Reported as:
Mean · Score
Change From Baseline to Day 3 and to Day 7 in Mean Sputum Color Score of Ambroxol Hydrochloride and Placebo
ScoreAmbroxol HydrochloridePlacebo
Change from baseline to Day 3-0.5 ± 0.77-0.5 ± 0.82
Change from baseline to Day 7-0.9 ± 0.99-0.8 ± 0.97
Statistical analysis
  • Ambroxol Hydrochloride vs Placebo · Modified Mann-Whitney U Statistic · p = 0.366
  • Ambroxol Hydrochloride vs Placebo · Modified Mann-Whitney U Statistic · p = 0.027
SecondaryChange From Baseline to Day 3 and to Day 7 in Mean Cough Severity Score of Ambroxol Hydrochloride and Placebo

The superiority of slow intravenous infusion of ambroxol hydrochloride to placebo in terms of change from baseline in cough score was demonstrated. Cough score was assessed by means of ordinal categorical 4-point scales \[0 = No cough, 1= Sporadic and mild cough, 2 = Moderate cough, 3 = Severe Cough\] with 0 = best and 3= worst.

Time frame:
From Baseline upto Day 3 and Day 7
Reported as:
Mean · Score
Change From Baseline to Day 3 and to Day 7 in Mean Cough Severity Score of Ambroxol Hydrochloride and Placebo
ScoreAmbroxol HydrochloridePlacebo
Change from baseline to Day 3-0.4 ± 0.52-0.5 ± 0.60
Change from baseline to Day 7-0.7 ± 0.68-0.6 ± 0.72
Statistical analysis
  • Ambroxol Hydrochloride vs Placebo · Modified Mann-Whitney U Statistic · p = 0.052
  • Ambroxol Hydrochloride vs Placebo · Modified Mann-Whitney U Statistic · p = 0.058
SecondaryChange From Baseline to Day 3 and to Day 7 in Mean Sputum Volume of Ambroxol Hydrochloride and Placebo

The superiority of slow intravenous infusion of ambroxol hydrochloride to placebo in terms of change from baseline in mean sputum volume was demonstrated. Patients collected 24-hour sputum (morning to same time of the following morning) in a graduated cup and volume was expressed as mL/24h.

Time frame:
From Baseline upto Day 3 and Day 7
Reported as:
Mean · mL/24h
Change From Baseline to Day 3 and to Day 7 in Mean Sputum Volume of Ambroxol Hydrochloride and Placebo
mL/24hAmbroxol HydrochloridePlacebo
Change from baseline to Day 3-4.53 ± 12.018-4.14 ± 12.235
Change from baseline to Day 7-9.73 ± 15.149-7.39 ± 15.999
Statistical analysis
  • Ambroxol Hydrochloride vs Placebo · Modified Mann-Whitney U Statistic · p = 0.309
  • Ambroxol Hydrochloride vs Placebo · Modified Mann-Whitney U Statistic · p = 0.006
Other pre-specifiedNumber of Participants With Adverse Events

The safety and tolerability of intravenous NAC 600 mg twice daily was demonstrated.

Time frame:
From screening to follow-up after the last administration of the investigational medicinal product (IMP) [assessed up to 19 months]
Reported as:
Count of participants · Participants
Number of Participants With Adverse Events
ParticipantsN-AcetylcysteineAmbroxol HydrochloridePlacebo
At least one AE827671
At least one TEAE676658
At least one IMP-related TEAE11110
At least one TEAE leading to drug withdrawal523
At least one TEAE leading to drug interruption001
At least one TEAE leading to fatal outcome100
At least one severe TEAE547
At least one TEAE of COVID-19000
At least one SAE257
At least one TESAE257
At least one TESAE leading to drug withdrawal111
At least one TESAE leading to drug interruption001
At least one TESAE leading to fatal outcome100
At least one TESAE of COVID-19000

Adverse events

Collected over From screening to follow-up after the last administration of the investigational medicinal product (IMP) [assessed up to 19 months].. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
N-Acetylcysteine1/108 (0.9%)2/108 (1.9%)67/108 (62%)
Ambroxol Hydrochloride0/110 (0%)5/110 (4.5%)66/110 (60%)
Placebo0/110 (0%)7/110 (6.4%)58/110 (52.7%)
Most frequent serious events
Showing 10 of 13
Most frequent serious events
EventN-AcetylcysteineAmbroxol HydrochloridePlacebo
Chronic obstructive pulmonary diseaseRespiratory, thoracic and mediastinal disorders0/1080/1102/110
Cardiac failureCardiac disorders1/1080/1100/110
Non-small lung cancerNeoplasms benign, malignant and unspecified (incl cysts and polyps)1/1080/1100/110
Arteriosclerosis coronary arteryCardiac disorders0/1081/1100/110
Anti-neutrophil cytoplasmic antibody positive vasculitisImmune system disorders0/1081/1100/110
HemoptysisRespiratory, thoracic and mediastinal disorders0/1081/1100/110
Coronary artery diseaseCardiac disorders0/1081/1100/110
Bronchopulmonary aspergillosis allergicInfections and infestations0/1081/1100/110
Benign prostatic hyperplasiaReproductive system and breast disorders0/1080/1101/110
Thyroid massEndocrine disorders0/1080/1101/110
Most frequent other events
Showing 10 of 210
Most frequent other events
EventN-AcetylcysteineAmbroxol HydrochloridePlacebo
HypokalaemiaMetabolism and nutrition disorders13/1089/1109/110
Renal cystRenal and urinary disorders1/1086/1103/110
Chronic gastritisGastrointestinal disorders4/1081/1101/110
PneumoniaInfections and infestations4/1083/1102/110
NephrolithiasisRenal and urinary disorders4/1083/1103/110
ConstipationGastrointestinal disorders2/1084/1102/110
DiarrhoeaGastrointestinal disorders3/1080/1104/110
Pulmonary massRespiratory, thoracic and mediastinal disorders1/1084/1101/110
Hepatic cystHepatobiliary disorders2/1083/1104/110
Intervertebral disc protrusionMusculoskeletal and connective tissue disorders0/1084/1100/110

Baseline characteristics

mITT population - The Modified ITT (mITT) Population comprised all participants in the ITT population who received at least 1 dose or partial dose of the Investigational Medicinal Product (IMP).

Age, Continuous
Age, Continuous(years)N-AcetylcysteineAmbroxol HydrochloridePlaceboTotal
Mean64.7 ± 11.6564.7 ± 12.7664.5 ± 12.7964.6 ± 12.38
Sex: Female, Male
Sex: Female, Male(Participants)N-AcetylcysteineAmbroxol HydrochloridePlaceboTotal
Female36313299
Male727978229
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)N-AcetylcysteineAmbroxol HydrochloridePlaceboTotal
Hispanic or Latino0000
Not Hispanic or Latino108110110328
Unknown or Not Reported0000
08

Study locations

32 sites
  • Wuxi Peoples' Hospital affiliated to Nanjing Medical University
    Wuxi, No. 299, Qing Yang Rd., Wuxi City, Jiangsu, China
  • Inner Mongolia Baogang Hospital
    Baotou, China
  • Beijing Hospital
    Beijing, China
  • Beijing Tongren Hospital
    Beijing, China
  • China-Japan Friendship Hospital
    Beijing, China
  • Peking University Shougang Hospital
    Beijing, China
  • Jilin Province People's Hospital
    Changchun, China
  • The First Bethune Hospital of Jilin University
    Changchun, China
  • Chengdu Fifth People's Hospital
    Chengdu, China
  • West China Hospital, Sichuan University
    Chengdu, China
  • The First Affiliated Hospital of Chongqing Medical University
    Chongqing, China
  • Deyang People's Hospital
    Deyang, China
  • Inner Mongolia People's Hospital
    Hohhot, China
  • Jinhua city central hospital/Jinhua hospital ,School of Medicine,Zhejiang UNIVERSITY
    Jinhua, China
  • Nanchang University-The Second Affiliated Hospital
    Nanchang, China
  • Nanjing First Hospital
    Nanjing, China
  • Zhongda Hospital, Southeast University - Pulmonology
    Nanjing, China
  • Jiangxi Pingxiang People's Hospital
    Pingxiang, China
  • Qingdao Municipal Hospital
    Qingdao, China
  • Minhang District Central Hospital
    Shanghai, China
  • Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
    Shanghai, China
  • Shanghai General Hospital
    Shanghai, China
  • Shanghai Pulmonary Hospital
    Shanghai, China
  • Suining Central Hospital
    Suining, China
  • First Hospital of Shanxi Medical University
    Taiyuan, China
  • The First Hospital of Shanxi Medical University
    Taiyuan, China
  • Tongji Hospital, Tongji Medical College of Huazhong University Science and Technology
    Wuhan, China
  • Wuxi Peoples' Hospital affiliated to Nanjing Medical University
    Wuxi, China
  • Yangzhou First People's Hospital
    Yangzhou, China
  • General Hospital of Ningxia Medical University
    Yinchuan, China
  • Affiliated Hospital of Guangdong Medical University - Respiration
    Zhanjiang, China
  • The First People's Hospital of Zigong
    Zigong, China
09

References and documents

Study documents

PDFs hosted by the registry, ClinicalTrials.gov.

10

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Ran from Jun 2019 to primary completion in Jan 2021, 18 months.

Results were first posted in Jan 2023, 1 year 11 months after primary completion.

Of 35 industry-sponsored phase 3 interventional studies under Respiratory Tract Diseases, half reached primary completion within 27 months of starting (the median), counting those still running; a quarter within 9 and three quarters within 45. This study's 18 months is below that.

Counting every sponsor, half of 41 studies reached it within 27 months; a quarter within 9 and three quarters within 47.

Respiratory Tract Diseases covers many different conditions, not one, so the studies compared here vary widely. Read these figures as a rough guide.

How these figures are worked out, and which studies are left out of them.

Registered
Feb 13, 2019
First posted
Feb 18, 2019
StartActual
Jun 25, 2019
Primary completionActual
Jan 23, 2021
CompletionActual
Feb 5, 2021
Results first posted
Jan 5, 2023
Last update
Sep 5, 2025
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Sep 5, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT03843541
Lead sponsor
Zambon SpA
Responsible party
Sponsor
First posted
Feb 18, 2019
Start date
Jun 25, 2019
Primary completion
Jan 23, 2021
Completion
Feb 5, 2021
Results posted
Jan 5, 2023
Last update
Sep 5, 2025

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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Studies of the drug tested here: Acetylcysteine

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