The Role of Vitamin C as Adjuvant Therapy in COVID-19
Poona Kumari, Suman Dembra, Pariya Dembra, Fnu Bhawna, Ambresha Gul, Basma Ali, Hamza Sohail, Besham Kumar, Muhammad Khizar Memon, Amber Rizwan
Cureus, doi:10.7759/cureus.11779
Background and objective The anti-inflammatory properties of vitamin C (VC) and the promising results it has shown in the treatment for common cold have prompted clinicians to use it as adjuvant therapy in the treatment of COVID-19. The purpose of this study was to find out the role of VC as adjunctive therapy in coronavirus disease 2019 .
Methodology This study was conducted from March to July 2020 in the COVID-19 unit of a tertiary care hospital in Karachi. In this randomized controlled trial (RCT), one group received the intervention [50 mg/kg/day of intravenous (IV) VC] along with the standard therapy, and the other group received standard therapy only. Data such as age, gender, vitals, and biochemical values as well as outcomes including the number of days required for treatment, hospital stay, need for ventilation, and mortality were compared between the two groups and recorded using a self-structured questionnaire.
Results COVID-19 patients who received IV VC became symptom-free earlier (7.1 ± 1.8 vs. 9.6 ± 2.1 days, p-value: <0.0001) and spent fewer days in the hospital (8.1 ± 1.8 vs. 10.7 ± 2.2 days, p-value: <0.0001) compared to those who received standard therapy only. However, there was no significant difference in the need for mechanical ventilation (p-value: 0.406) and mortality (p-value: 0.31) between the two groups.
Conclusion VC can significantly improve clinical symptoms in patients affected with COVID-19; however, it had no impact on mortality and the need for mechanical ventilation. More large-scale studies are required to further assess the role of VC in the treatment of COVID-19.
Additional Information Disclosures Human subjects: Consent was obtained by all participants in this study. Ghulam Muhammad Mahar Medical College IRB issued approval GMMMC/20/03-4 (electronic). This study was approved by Ghulam Muhammad Mahar Medical College IRB. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
References
Biancatelli, Berrill, Catravas, Marik, Quercetin and vitamin C: an experimental, synergistic therapy for the prevention and treatment of SARS-CoV-2 related disease (COVID-19), Front Immunol,
doi:10.3389/fimmu.2020.01451
Cheng, Can early and high intravenous dose of vitamin C prevent and treat coronavirus disease 2019 (COVID-19)?, Med Drug Discov,
doi:10.1016/j.medidd.2020.100028
Fowler Aa 3rd, Truwit, Hite, 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,
doi:10.1001/jama.2019.11825
Hemilä, Chalker, Vitamin C may reduce the duration of mechanical ventilation in critically ill patients: a meta-regression analysis, J Intensive Care,
doi:10.1186/s40560-020-0432-y
Hoang, Shaw, Fang, Han, Possible application of high-dose vitamin C in the prevention and therapy of coronavirus infection, J Glob Antimicrob Resist,
doi:10.1016/j.jgar.2020.09.025
Jafarnejad, Boccardi, Hosseini, Taghizadeh, Hamedifard, A meta-analysis of randomized control trials: the impact of vitamin C supplementation on serum CRP and serum hs-CRP concentrations, Curr Pharm Des,
doi:10.2174/1381612824666181017101810
Johnston, Barkyoumb, Schumacher, Vitamin C supplementation slightly improves physical activity levels and reduces cold incidence in men with marginal vitamin C status: a randomized controlled trial, Nutrients,
doi:10.3390/nu6072572
Marik, Khangoora, Rivera, Hooper, Catravas, Hydrocortisone, vitamin C, and thiamine for the treatment of severe sepsis and septic shock: a retrospective before-after study, Chest,
doi:10.1016/j.chest.2016.11.036
Ran, Zhao, Wang, Wang, Zhao et al., Extra dose of vitamin C based on a daily supplementation shortens the common cold: a meta-analysis of 9 randomized controlled trials, Biomed Res Int,
doi:10.1155/2018/1837634
Vorilhon, Arpajou, Roussel, Pereira, Cabaillot, Efficacy of vitamin C for the prevention and treatment of upper respiratory tract infection. A meta-analysis in children, Eur J Clin Pharmacol,
doi:10.1007/s00228-018-2601-7
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"year": "2020"
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