Dietary supplements to reduce symptom severity and duration in people with SARS-CoV-2: a double-blind randomised controlled trial

DOI record: { "DOI": "10.1136/bmjopen-2023-073761", "ISSN": [ "2044-6055", "2044-6055" ], "URL": "http://dx.doi.org/10.1136/bmjopen-2023-073761", "abstract": "<jats:sec><jats:title>Background</jats:title><jats:p>COVID-19 has caused morbidity, hospitalisation and mortality worldwide. Despite effective vaccines, there is still a need for effective treatments, especially for people in the community. Dietary supplements have long been used to treat respiratory infections, and preliminary evidence indicates some may be effective in people with COVID-19. We sought to evaluate whether a combination of vitamin C, vitamin D<jats:sub>3</jats:sub>, vitamin K<jats:sub>2</jats:sub>and zinc could improve overall health and decrease symptom burden in outpatients diagnosed with COVID-19.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Participants were randomised to receive either vitamin C (6 g), vitamin D<jats:sub>3</jats:sub>(1000 units), vitamin K<jats:sub>2</jats:sub>(240 μg) and zinc acetate (75 mg) or placebo daily for 21 days and were followed for 12 weeks. An additional loading dose of 50 000 units vitamin D<jats:sub>3</jats:sub>(or placebo) was given on day one. The primary outcome was participant-reported overall health using the EuroQol Visual Assessment Scale summed over 21 days. Secondary outcomes included health status, symptom severity, symptom duration, delayed return to usual health, frequency of hospitalisation and mortality.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>90 patients (46 control, 44 treatment) were randomised. The study was stopped prematurely due to insufficient capacity for recruitment. The mean difference (control–treatment) in cumulative overall health was −37.4 (95% CI −157.2 to 82.3), p=0.53 on a scale of 0–2100. No clinically or statistically significant differences were seen in any secondary outcomes.</jats:p></jats:sec><jats:sec><jats:title>Interpretation</jats:title><jats:p>In this double-blind, placebo-controlled, randomised trial of outpatients diagnosed with COVID-19, the dietary supplements vitamin C, vitamin D<jats:sub>3</jats:sub>, vitamin K<jats:sub>2</jats:sub>and zinc acetate showed no clinically or statistically significant effects on the documented measures of health compared with a placebo when given for 21 days. Termination due to feasibility limited our ability to demonstrate the efficacy of these supplements for COVID-19. Further research is needed to determine clinical utility.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p><jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04780061\">NCT04780061</jats:ext-link>.</jats:p></jats:sec>", "alternative-id": [ "10.1136/bmjopen-2023-073761" ], "author": [ { "ORCID": "http://orcid.org/0000-0003-4893-5254", "affiliation": [], "authenticated-orcid": false, "family": "Seely", "given": "Dugald", "sequence": "first" }, { "ORCID": "http://orcid.org/0000-0003-4417-1656", "affiliation": [], "authenticated-orcid": false, "family": "Legacy", "given": "Mark", "sequence": "additional" }, { "affiliation": [], "family": "Conte", "given": "Ellen", "sequence": "additional" }, { "affiliation": [], "family": "Keates", "given": "Caitlyn", "sequence": "additional" }, { "affiliation": [], "family": "Psihogios", "given": "Athanasios", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0001-8478-8170", "affiliation": [], "authenticated-orcid": false, "family": "Ramsay", "given": "Tim", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-3389-2485", "affiliation": [], "authenticated-orcid": false, "family": "Fergusson", "given": "Dean A", "sequence": "additional" }, { "affiliation": [], "family": "Kanji", "given": "Salmaan", "sequence": "additional" }, { "affiliation": [], "family": "Simmons", "given": "John-Graydon", "sequence": "additional" }, { "affiliation": [], "family": "Wilson", "given": "Kumanan", "sequence": "additional" } ], "clinical-trial-number": [ { "clinical-trial-number": "nct04780061", "registry": "10.18810/clinical-trials-gov" } ], "container-title": "BMJ Open", "container-title-short": "BMJ Open", "content-domain": { "crossmark-restriction": true, "domain": [ "bmj.com" ] }, "created": { "date-parts": [ [ 2023, 9, 22 ] ], "date-time": "2023-09-22T15:30:29Z", "timestamp": 1695396629000 }, "deposited": { "date-parts": [ [ 2023, 9, 22 ] ], "date-time": "2023-09-22T15:30:45Z", "timestamp": 1695396645000 }, "indexed": { "date-parts": [ [ 2023, 9, 23 ] ], "date-time": "2023-09-23T14:47:10Z", "timestamp": 1695480430155 }, "is-referenced-by-count": 0, "issue": "9", "issued": { "date-parts": [ [ 2023, 9 ] ] }, "journal-issue": { "issue": "9", "published-online": { "date-parts": [ [ 2023, 9, 22 ] ] }, "published-print": { "date-parts": [ [ 2023, 9 ] ] } }, "language": "en", "license": [ { "URL": "http://creativecommons.org/licenses/by-nc/4.0/", "content-version": "unspecified", "delay-in-days": 21, "start": { "date-parts": [ [ 2023, 9, 22 ] ], "date-time": "2023-09-22T00:00:00Z", "timestamp": 1695340800000 } } ], "link": [ { "URL": "https://syndication.highwire.org/content/doi/10.1136/bmjopen-2023-073761", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "239", "original-title": [], "page": "e073761", "prefix": "10.1136", "published": { "date-parts": [ [ 2023, 9 ] ] }, "published-online": { "date-parts": [ [ 2023, 9, 22 ] ] }, "published-print": { "date-parts": [ [ 2023, 9 ] ] }, "publisher": "BMJ", "reference": [ { "DOI": "10.1177/13505084221090632", "article-title": "'Anarchist technologies': anarchism, cybernetics and mutual aid in community responses to the COVID-19 crisis", "author": "Swann", "doi-asserted-by": "crossref", "first-page": "193", "journal-title": "Organization (Lond)", "key": "2023092208301025000_13.9.e073761.1", "volume": "30", "year": "2023" }, { "DOI": "10.1056/NEJMoa2034577", "doi-asserted-by": "publisher", "key": "2023092208301025000_13.9.e073761.2" }, { "DOI": "10.1016/S2213-2600(21)00407-0", "article-title": "Does infection with or vaccination against SARS-Cov-2 lead to lasting immunity?", "author": "Milne", "doi-asserted-by": "crossref", "first-page": "1450", "journal-title": "Lancet Respir Med", "key": "2023092208301025000_13.9.e073761.3", "volume": "9", "year": "2021" }, { "DOI": "10.3389/fimmu.2021.714170", "doi-asserted-by": "publisher", "key": "2023092208301025000_13.9.e073761.4" }, { "DOI": "10.3389/fimmu.2020.01817", "doi-asserted-by": "crossref", "key": "2023092208301025000_13.9.e073761.5", "unstructured": "Frederiksen LSF , Zhang Y , Foged C , et al . 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