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A new clinical trial to test high-dose vitamin C in patients with COVID-19

DOI:10.1186/s13054-020-02851-4
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Anitra C Carr at University of Otago
Anitra C Carr
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L E T T E R Open Access
A new clinical trial to test high-dose
vitamin C in patients with COVID-19
Anitra C. Carr
With the 2019 novel coronavirus (2019-nCoV) outbreak
now spreading across the world, people are seeking ways
in which to potentially protect themselves from the virus
or to alleviate its effects once caught. One such means that
is being touted online and in the media is vitamin C.
Vitamin C is best known for its antioxidant properties,
being able to scavenge damaging reactive oxygen species,
thus protecting the body’s cells and tissues from oxida-
tive damage and dysfunction. However, the vitamin also
has numerous other important functions within the
body, many of which are known to support healthy im-
mune function. During infection, vitamin C levels can
become depleted and a person’s requirement for vitamin
C increases with the severity of the infection [1]. In se-
vere cases, this may require intravenous administration
of gram doses in order to achieve high enough levels in
the body to compensate for the enhanced turnover of
the vitamin.
As of February 2020, the clinical characteristics of pa-
tients hospitalized with COVID-19-related pneumonia in-
dicated that 26% were transferred to the ICU because of
complications such as ARDS and shock [2]. A recently
published RCT carried out in the USA in 167 patients
with sepsis-related ARDS indicated that administration of
~ 15 g/day of IV vitamin C for 4 days may decrease mor-
tality in these patients [3]. An earlier IV vitamin C trial of
patients admitted to the ICU with pneumonia included
hydrocortisone administration [4], however, systemic cor-
ticosteroid treatment has not been shown to have signifi-
cant benefits in patients with COVID-19 [5].
Just recently registered on clincialtrials.gov (Identifier:
NCT04264533), a new clinical trial to investigate vitamin
C infusion for the treatment of severe 2019-nCoV in-
fected pneumonia has begun in Wuhan, China. This is
one of the first RCTs to test the effects of IV vitamin C
in patients infected with this virus. In this trial, the in-
vestigators will treat 140 patients with a placebo control
or intravenous vitamin C at a dose of 24 g/day for 7 days.
They will assess requirements for mechanical ventilation
and vasopressor drugs, organ failure scores, ICU length
of stay and 28-day mortality.
The investigators of the new study hope to complete
the trial by the end of September. Although the findings
of this trial will be too late for the many thousands of
people currently infected with the virus, the study will
nevertheless provide valuable information as to the po-
tential mitigation of symptoms by vitamin C during fu-
ture viral outbreaks.
Acknowledgements
ACC is the recipient of a Health Research Council of New Zealand Sir Charles
Hercus Health Research Fellowship.
Author’s contributions
ACC wrote the letter. The author read and approved the final manuscript.
Funding
None
Availability of data and materials
N/A
Ethics approval and consent to participate
N/A
Consent for publication
N/A
Competing interests
None
Received: 10 March 2020 Accepted: 25 March 2020
References
1. Carr AC, Rosengrave PC, Bayer S, Chambers S, Mehrtens J, Shaw GM.
Hypovitaminosis C and vitamin C deficiency in critically ill patients despite
recommended enteral and parenteral intakes. Crit Care. 2017;21:300.
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
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appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if
changes were made. The images or other third party material in this article are included in the article's Creative Commons
licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons
licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain
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Correspondence: anitra.carr@otago.ac.nz
Department of Pathology & Biomedical Science, University of Otago,
Christchurch, PO Box 4345, Christchurch 8140, New Zealand
Carr Critical Care (2020) 24:133
https://doi.org/10.1186/s13054-020-02851-4
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Carr Critical Care (2020) 24:133 Page 2 of 2
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Full-text available
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Abstract Background Vitamin C is an essential water-soluble nutrient which cannot be synthesised or stored by humans. It is a potent antioxidant with anti-inflammatory and immune-supportive roles. Previous research has indicated that vitamin C levels are depleted in critically ill patients. In this study we have assessed plasma vitamin C concentrations in critically ill patients relative to infection status (septic shock or non-septic) and level of inflammation (C-reactive protein concentrations). Vitamin C status was also assessed relative to daily enteral and parenteral intakes to determine if standard intensive care unit (ICU) nutritional support is adequate to meet the vitamin C needs of critically ill patients. Methods Forty-four critically ill patients (24 with septic shock, 17 non-septic, 3 uncategorised) were recruited from the Christchurch Hospital Intensive Care Unit. We measured concentrations of plasma vitamin C and a pro-inflammatory biomarker (C-reactive protein) daily over 4 days and calculated patients’ daily vitamin C intake from the enteral or total parenteral nutrition they received. We compared plasma vitamin C and C-reactive protein concentrations between septic shock and non-septic patients over 4 days using a mixed effects statistical model, and we compared the vitamin C status of the critically ill patients with known vitamin C bioavailability data using a four-parameter log-logistic response model. Results Overall, the critically ill patients exhibited hypovitaminosis C (i.e.
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