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

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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 bodys 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 persons 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.
Authors 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,
which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give
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
permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the
data made available in this article, unless otherwise stated in a credit line to the data.
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
2. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z,
Xiong Y, Zhao Y, Li Y, Wang X, Peng Z. Clinical characteristics of 138
hospitalized patients with 2019 novel coronavirus-infected pneumonia in
Wuhan, China. JAMA. 2020;323(11):1061-9.
3. Fowler AA 3rd, Truwit JD, Hite RD, Morris PE, DeWilde C, Priday A, Fisher B,
Thacker LR 2nd, Natarajan R, Brophy DF, Sculthorpe R, Nanchal R, Syed A,
Sturgill J, Martin GS, Sevransky J, Kashiouris M, Hamman S, Egan KF, Hastings
A, Spencer W, Tench S, Mehkri O, Bindas J, Duggal A, Graf J, Zellner S,
Yanny L, McPolin C, Hollrith T, Kramer D, Ojielo C, Damm T, Cassity E,
Wieliczko A, Halquist M. Effect of vitamin C infusion on organ failure and
biomarkers of inflammation and vascular injury in patients with sepsis and
severe acute respiratory failure: the CITRIS-ALI randomized clinical trial.
JAMA. 2019;322(13):126170.
4. Kim WY, Jo EJ, Eom JS, Mok J, Kim MH, Kim KU, Park HK, Lee MK, Lee K.
Combined vitamin C, hydrocortisone, and thiamine therapy for patients
with severe pneumonia who were admitted to the intensive care unit:
propensity score-based analysis of a before-after cohort study. J Crit Care.
2018;47:2118.
5. Liu K, Fang YY, Deng Y, Liu W, Wang MF, Ma JP, Xiao W, Wang YN, Zhong
MH, Li CH, Li GC, Liu HG. Clinical characteristics of novel coronavirus cases
in tertiary hospitals in Hubei Province. Chin Med J. 2020. https://doi.org/10.
1097/CM9.0000000000000744.
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... In addition to its nutritional significance, AA is also used in medical practice and in clinical trials for the treatment of many diseases including hypovitaminosis C, severe pneumonia, severe acute respiratory failure, coronary artery disease, Type 2 diabetes, dementia, Alzheimer's disease, and COVID-19 [7][8][9][10][11][12][13]. However, the benefit of using this dietary antioxidant in prophylactics and the treatment of cancer has been under debate mentia, Alzheimer's disease, and COVID-19 [7][8][9][10][11][12][13]. ...
... In addition to its nutritional significance, AA is also used in medical practice and in clinical trials for the treatment of many diseases including hypovitaminosis C, severe pneumonia, severe acute respiratory failure, coronary artery disease, Type 2 diabetes, dementia, Alzheimer's disease, and COVID-19 [7][8][9][10][11][12][13]. However, the benefit of using this dietary antioxidant in prophylactics and the treatment of cancer has been under debate mentia, Alzheimer's disease, and COVID-19 [7][8][9][10][11][12][13]. However, the benefit of using this dietary antioxidant in prophylactics and the treatment of cancer has been under debate for several decades already [14][15][16][17][18][19][20][21][22][23][24][25][26]. ...
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... During an infection, vitamin C levels can become depleted and a person's requirement for vitamin C increases with the severity of the infection. As of February 2020, the clinical characteristics of patients hospitalized with COVID-19-related pneumonia indicated that 26% [76] . One trial with 140 patients, IV vitamin C was administered to ICU patients with pneumonia at a dose of 24 g/day for 7 days along with hydrocortisone to the therapy, however, this combination did not result any benefits for patients with COVID-19 [77] . ...
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Purpose: To evaluate the efficacy of combined vitamin C, hydrocortisone, and thiamine in patients with severe pneumonia. Materials and Methods: All consecutive patients with severe pneumonia who were treated with the vitamin C protocol (6 g of vitamin C per day) in June 2017–January 2018 (n = 53) were compared to all consecutive patients with severe pneumonia who were treated in June 2016–January 2017 (n = 46). Propensity score analysis was used to adjust for potential baseline differences between the groups. Results: In the propensity-matched cohort (n = 36/group), the treated patients had significantly less hospital mortality than the control group (17% vs. 39%; P = 0.04). The vitamin C protocol associated independently with decreased mortality in propensity score-adjusted analysis (adjusted odds ratio = 0.15, 95% confidence interval = 0.04–0.56, P = 0.005). Relative to the control group, the treatment group had a significantly higher median improvement in the radiologic score at day 7 compared with baseline (4 vs. 2; P = 0.045). The vitamin C protocol did not increase the rates of acute kidney injury or superinfection. Conclusions: Combined vitamin C, hydrocortisone, and thiamine therapy may benefit patients with severe pneumonia.
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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. ResultsOverall, the critically ill patients exhibited hypovitaminosis C (i.e., < 23 μmol/L), with a mean plasma vitamin C concentration of 17.8 ± 8.7 μmol/L; of these, one-third had vitamin C deficiency (i.e., < 11 μmol/L). Patients with hypovitaminosis C had elevated inflammation (C-reactive protein levels; P < 0.05). The patients with septic shock had lower vitamin C concentrations and higher C-reactive protein concentrations than the non-septic patients (P < 0.05). Nearly 40% of the septic shock patients were deficient in vitamin C, compared with 25% of the non-septic patients. These low vitamin C levels were apparent despite receiving recommended intakes via enteral and/or parenteral nutritional therapy (mean 125 mg/d). Conclusions Critically ill patients have low vitamin C concentrations despite receiving standard ICU nutrition. Septic shock patients have significantly depleted vitamin C levels compared with non-septic patients, likely resulting from increased metabolism due to the enhanced inflammatory response observed in septic shock.