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Impact of uricosurics on mortality outcomes in patients with COVID-19: a systematic review and meta-analysis of randomized controlled trials

Kow et al., International Journal of Pharmacy Practice, doi:10.1093/ijpp/riae003

Mar 2024

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Vitamin C for COVID-19

6th treatment shown to reduce risk in September 2020

^*, now known with p = 0.000000087 from 70 studies, recognized in 11 countries.

Lower risk for mortality, ICU admission, hospitalization, and recovery.

No treatment is 100% effective. Protocols combine complementary and synergistic treatments. ^* >10% efficacy in meta analysis with ≥3 clinical studies.

4,100+ studies for 60+ treatments. c19early.org

Systematic review and meta analysis of 27 RCTs investigating the impact of uricosuric drugs on mortality in COVID-19 patients. The pooled analysis found no significant association between uricosuric use and mortality risk. However, a subgroup analysis of 10 trials showed lower mortality with vitamin C.

6 meta analyses show significant improvements with vitamin C for mortality Bhowmik, Kow, Kow (B), Olczak-Pruc, progression Sun, severity Bhowmik, and cases Xu.

Currently there are 70 vitamin C for COVID-19 studies, showing 19% lower mortality [9‑27%], 9% lower ventilation [-12‑27%], 14% lower ICU admission [3‑24%], 19% lower hospitalization [6‑30%], and 4% more cases [-13‑25%].

1. Bhowmik et al., Impact of high-dose vitamin C on the mortality, severity, and duration of hospital stay in COVID-19 patients: A meta-analysis, Health Science Reports, doi:10.1002/hsr2.762.wiley.com, doi.org.

2. Kow et al., The effect of vitamin C on the risk of mortality in patients with COVID-19: a systematic review and meta-analysis of randomized controlled trials, Inflammopharmacology, doi:10.1007/s10787-023-01200-5.springer.com, doi.org.

3. Kow (B) et al., Impact of uricosurics on mortality outcomes in patients with COVID-19: a systematic review and meta-analysis of randomized controlled trials, International Journal of Pharmacy Practice, doi:10.1093/ijpp/riae003.oup.com, doi.org.

4. Olczak-Pruc et al., Vitamin C Supplementation for the Treatment of COVID-19: A Systematic Review and Meta-Analysis, Nutrients, doi:10.3390/nu14194217.mdpi.com, doi.org.

5. Sun et al., Therapeutic effects of high-dose vitamin C supplementation in patients with COVID-19: a meta-analysis, Nutrition Reviews, doi:10.1093/nutrit/nuad105.oup.com, doi.org.

6. Xu et al., Association of Oral or Intravenous Vitamin C Supplementation with Mortality: A Systematic Review and Meta-Analysis, Nutrients, doi:10.3390/nu15081848.mdpi.com, doi.org.

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risk of death, 50.0% lower, OR 0.50, p = 0.008, RR approximated with OR.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

Kow et al., 4 Mar 2024, peer-reviewed, 4 authors. Contact: kaeshaelya@gmail.com.

This Paper Vitamin C All

Impact of uricosurics on mortality outcomes in patients with COVID-19: a systematic review and meta-analysis of randomized controlled trials

Chia Siang Kow, Dinesh Sangarran Ramachandram, Shahzad Syed, Hasan, Kaeshaelya Thiruchelvam

Objectives: To determine risks associated with uricosurics in COVID-19 patients. Methods: A systematic review and meta-analysis was conducted by systematically searching electronic databases. Key findings: The pooled analysis of the included trials revealed that the use of uricosurics was not associated with the risk of mortality (pooled odds ratio [OR] = 1.03, 95% confidence interval [CI]: 0.94-1.12). However, there is a potential mortality benefit associated with the use of ascorbic acid (pooled OR = 0.78, 95% CI: 0.65-0.94). Conclusions: The findings confirmed the safety of uricosurics in COVID-19 patients, despite their potential to cause uric acid excretion, which may possess antioxidant properties.

Supplementary material Supplementary data are available at International journal of Pharmacy Practice online. validation; roles/writing-original draft; writing-review & editing; final approval of the version to be published. All authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The manuscript has been seen and approved by all authors. We confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. All authors had complete access to the study data that support the publication. Author contributions Conflict of interest The authors have no conflicts of interest to declare that are relevant to the content of this article.

References

Dufour, Werion, Belkhir, Serum uric acid, disease seeverity and outcomes in COVID-19, Crit Care, doi:10.1186/s13054-021-03616-3

Kow, Hasan, Ramachandram, The effect of vitamin C on the risk of mortality in patients with COVID-19: a systematic review and meta-analysis of randomized controlled trials, Inflammopharmacology, doi:10.1093/ijpp/riae003/7619074bygueston05

Kurajoh, Hiura, Numaguchi, Inflammation related to asssociation of low uric acid and progression to severe disease in patients hospitalized for non-severe Coronavirus disease 2019, Biomedicines, doi:10.3390/biomedicines11030854

Sautin, Johnson, Uric acid: the oxidant-antioxidant parRadox, Nucleos Nucleot Nucl Acids, doi:10.1080/15257770802138558

Topless, Gaffo, Stamp, Gout and the risk of COVID-19 diagnosis and death in the UK Biobank: a population-based study, Lancet Rheumatol, doi:10.1016/S2665-9913(21)00401-X

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