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11 were in the final stages of clinical trials as of June 2024 [114] Among others, Hangzhou Jiuyuan Gene Engineering, The United Laboratories, CSPC Pharmaceutical Group, Huadong Medicine (which also holds a majority stake in Jiuyuan Gene [117] ) and Sihuan Pharmaceutical were all preparing generic offerings

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A Cochrane systematic review of NAC for COPD exacerbations (39 RCTs, n=7,436) found that NAC and other mucolytics significantly reduced the frequency of acute exacerbations (OR 0.75, 95% CI 0.62-0.92) (Poole et al., Cochrane Database Syst Rev, 2019) [43]

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