Effect of High-Dose Zinc and Ascorbic Acid Supplementation vs Usual Care on Symptom Length and Reduction Among Ambulatory Patients With SARS-CoV-2 Infection
MD, MBA Suma Thomas, MD, MS Divyang Patel, BSN, RN Barbara Bittel, MPH Kathy Wolski, MS Qiuqing Wang, MD, MS Anirudh Kumar, Zachary J Il’giovine, MD, MS Reena Mehra, MD Carla Mcwilliams, MD Steve E Nissen, MD, MBA Milind Y Desai
JAMA Network Open, doi:10.1001/jamanetworkopen.2021.0369
IMPORTANCE There is limited evidence regarding early treatment of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to mitigate symptom progression. OBJECTIVE To examine whether high-dose zinc and/or high-dose ascorbic acid reduce the severity or duration of symptoms compared with usual care among ambulatory patients with SARS-CoV-2 infection. DESIGN, SETTING, AND PARTICIPANTS This multicenter, single health system randomized clinical factorial open-label trial enrolled 214 adult patients with a diagnosis of SARS-CoV-2 infection confirmed with a polymerase chain reaction assay who received outpatient care in sites in Ohio and
ARTICLE INFORMATION Additional Contributions: Serpil Erzurum, MD, James Young, MD, Daniel Culver, MD, Joan Booth, RN, Nancy Obuchowski, MPH, and John Petrich, RPh (Cleveland Clinic), were members of the operational and safety monitoring board. They were not compensated for their time. We would like to thank Samantha Xu, BS (Cleveland Clinic), for help with logistics of study set-up and coordination. She was compensated for her time.
References
Eby, Davis, Halcomb, Reduction in duration of common colds by zinc gluconate lozenges in a double-blind study, Antimicrob Agents Chemother,
doi:10.1128/AAC.25.1.20
Hemilä, Zinc lozenges and the common cold: a meta-analysis comparing zinc acetate and zinc gluconate, and the role of zinc dosage, JRSM Open,
doi:10.1177/2054270417694291
Krenn, Gaudernak, Holzer, Lanke, Van Kuppeveld et al., Antiviral activity of the zinc ionophores pyrithione and hinokitiol against picornavirus infections, J Virol,
doi:10.1128/JVI.01543-08
Li, Moore, Vasilieva, Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus, Nature,
doi:10.1038/nature02145
Velthuis, Van Den Worm, Sims, Baric, Snijder et al., Zn(2+) inhibits coronavirus and arterivirus RNA polymerase activity in vitro and zinc ionophores block the replication of these viruses in cell culture, PLoS Pathog,
doi:10.1371/journal.ppat.1001176
Wang, Il'giovine, Mehra, Nissen, Desai, None
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'article-title': 'Clinical features of patients infected with 2019 novel coronavirus in '
'Wuhan, China.',
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'author': 'Huang',
'year': '2020',
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'from the Chinese Center for Disease Control and Prevention.',
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'DOI': '10.3390/nu9060624',
'article-title': 'Zinc in infection and inflammation.',
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'author': 'Gammoh',
'year': '2017',
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'key': 'zoi210024r5',
'doi-asserted-by': 'crossref',
'DOI': '10.3390/nu9040339',
'article-title': 'Vitamin C and infections.',
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'author': 'Hemilä',
'year': '2017',
'journal-title': 'Nutrients'},
{ 'issue': '1',
'key': 'zoi210024r6',
'article-title': 'Vitamin C for preventing and treating the common cold.',
'author': 'Hemilä',
'year': '2013',
'journal-title': 'Cochrane Database Syst Rev'},
{ 'issue': '2',
'key': 'zoi210024r7',
'doi-asserted-by': 'crossref',
'DOI': '10.1002/14651858.CD001364.pub3',
'article-title': 'Zinc for the common cold.',
'author': 'Singh',
'year': '2011',
'journal-title': 'Cochrane Database Syst Rev'},
{ 'issue': '1',
'key': 'zoi210024r8',
'doi-asserted-by': 'publisher',
'first-page': '20',
'DOI': '10.1128/AAC.25.1.20',
'article-title': 'Reduction in duration of common colds by zinc gluconate lozenges in a '
'double-blind study.',
'volume': '25',
'author': 'Eby',
'year': '1984',
'journal-title': 'Antimicrob Agents Chemother'},
{ 'issue': '5',
'key': 'zoi210024r9',
'doi-asserted-by': 'crossref',
'DOI': '10.1177/2054270417694291',
'article-title': 'Zinc lozenges and the common cold: a meta-analysis comparing zinc '
'acetate and zinc gluconate, and the role of zinc dosage.',
'volume': '8',
'author': 'Hemilä',
'year': '2017',
'journal-title': 'JRSM Open'},
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'key': 'zoi210024r10',
'doi-asserted-by': 'publisher',
'first-page': '265',
'DOI': '10.1186/s13054-019-2538-y',
'article-title': 'Vitamin C administration in the critically ill: a summary of recent '
'meta-analyses.',
'volume': '23',
'author': 'Carr',
'year': '2019',
'journal-title': 'Crit Care'},
{ 'issue': '11',
'key': 'zoi210024r11',
'doi-asserted-by': 'crossref',
'DOI': '10.1371/journal.ppat.1001176',
'article-title': 'Zn(2+) inhibits coronavirus and arterivirus RNA polymerase activity in '
'vitro and zinc ionophores block the replication of these viruses in '
'cell culture.',
'volume': '6',
'author': 'te Velthuis',
'year': '2010',
'journal-title': 'PLoS Pathog'},
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'key': 'zoi210024r12',
'doi-asserted-by': 'publisher',
'first-page': '450',
'DOI': '10.1038/nature02145',
'article-title': 'Angiotensin-converting enzyme 2 is a functional receptor for the SARS '
'coronavirus.',
'volume': '426',
'author': 'Li',
'year': '2003',
'journal-title': 'Nature'},
{ 'issue': '1',
'key': 'zoi210024r13',
'doi-asserted-by': 'publisher',
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'DOI': '10.1128/JVI.01543-08',
'article-title': 'Antiviral activity of the zinc ionophores pyrithione and hinokitiol '
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'author': 'Hemilä',
'year': '2003',
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'DOI': '10.1080/03079459208418879',
'article-title': 'Ascorbic acid and infectious bronchitis infections in broilers.',
'volume': '21',
'author': 'Davelaar',
'year': '1992',
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'article-title': 'Zinc gluconate lozenges for common cold: a double-blind clinical trial.',
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'author': 'Weismann',
'year': '1990',
'journal-title': 'Dan Med Bull'},
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