No significant benefit of moderate-dose vitamin C on severe COVID-19 cases
Zheng et al.
, No significant benefit of moderate-dose vitamin C on severe COVID-19 cases
, Open Medicine, doi:10.1515/med-2021-0361
Retrospective 397 severe COVID-19 patients in China, showing worse outcomes with vitamin C treatment, without statistical significance. IV vitamin C 2-4g/day. Subject to confounding by indication
and immortal time bias
. Exclusion criteria were (a) the duration of hospitalization was less than 3 days; (b) vitamin C treatment started before admission; and (c) the length of vitamin C use was less than 3 days. Includes vitamin C use started at any time during hospitalization, for many patients this was >15 days later (Figure A2). Duration of treatment varied widely (Figure A1). Treatment was determined by clinicians according to the condition of each patient.
This study is excluded in the after exclusion results of meta
substantial unadjusted confounding by indication
likely; immortal time bias
may significantly affect results; treatment start times unknown, treatment may not have started at baseline.
risk of death, 157.0% higher, HR 2.57, p = 0.33, treatment 12 of 70 (17.1%), control 7 of 327 (2.1%), adjusted per study, propensity score matching.
risk of death, 169.0% higher, HR 2.69, p = 0.07, treatment 12 of 70 (17.1%), control 7 of 327 (2.1%), adjusted per study, IPTW.
clinical improvement ≥ 2 points, 35.1% worse, HR 1.35, p = 0.17, treatment 18 of 70 (25.7%), control 16 of 327 (4.9%), adjusted per study, inverted to make HR<1 favor treatment, propensity score matching.
clinical improvement ≥ 2 points, 31.6% worse, HR 1.32, p = 0.11, treatment 18 of 70 (25.7%), control 16 of 327 (4.9%), adjusted per study, inverted to make HR<1 favor treatment, IPTW.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Zheng et al., 22 Sep 2021, retrospective, China, peer-reviewed, 10 authors, study period 13 February, 2020 - 29 February, 2020.
Abstract: Open Medicine 2021; 16: 1403–1414
Shaoping Zheng#, Qiaosen Chen#, Hongbo Jiang#, Chunxia Guo, Jinzhuo Luo, Sumeng Li,
Hua Wang, Huadong Li, Xin Zheng, Zhihong Weng*
No signiﬁcant beneﬁt of moderate-dose vitamin C
on severe COVID-19 cases
received March 22, 2021; accepted August 21, 2021
Abstract: There is no speciﬁc drug for coronavirus disease 2019 (COVID-19). We aimed to investigate the possible clinical eﬃcacy of moderate-dose vitamin C infusion
among inpatients with severe COVID-19. Data of 397 adult
patients with severe COVID-19 admitted to a designated
clinical center of Wuhan Union Hospital (China) between
February 13 and February 29, 2020, were collected. Besides
standard therapies, patients were treated with vitamin C
(2–4 g/day) or not. The primary outcome was all-cause
death. Secondary outcome was clinical improvement of
2 points on a 6-point ordinal scale. About 70 participants
were treated with intravenous vitamin C, and 327 did not
receive it. No signiﬁcant association was found between
vitamin C use and death on inverse probability treatment
weighting (IPTW) analysis (weighted hazard ratio [HR],
# These authors contributed equally to this manuscript.
* Corresponding author: Zhihong Weng, Department of Infectious
Diseases, Union Hospital, Tongji Medical College, Huazhong
University of Science and Technology, Wuhan, China; Joint
International Laboratory of Infection and Immunity, Huazhong
University of Science and Technology, Wuhan, China,
Shaoping Zheng: Department of Ultrasound, Union Hospital, Tongji
Medical College, Huazhong University of Science and Technology,
Qiaosen Chen, Hongbo Jiang: Department of Epidemiology and
Biostatistics, School of Public Health, Guangdong Pharmaceutical
University, Guangzhou, China
Chunxia Guo, Jinzhuo Luo, Sumeng Li, Hua Wang, Xin Zheng:
Department of Infectious Diseases, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan,
Huadong Li: Department of Infectious Diseases, Wuhan Jinyintan
Hospital, Wuhan, China
Xin Zheng: Joint International Laboratory of Infection and Immunity,
Huazhong University of Science and Technology, Wuhan, China
Open Access. © 2021 Shaoping Zheng et al., published by De Gruyter.
2.69; 95% conﬁdence interval [CI], 0.91–7.89). Clinical
improvement occurred in 74.3% (52/70) of patients in the
vitamin C group and 95.1% (311/327) in the no vitamin C
group. No signiﬁcant diﬀerence was observed between the
two groups on IPTW analysis (weighted HR, 0.76; 95% CI,
0.55–1.07). Our ﬁndings revealed that in patients with
severe COVID-19, treatment with moderate dose of intravenous vitamin C had no signiﬁcant beneﬁt on reducing
the risk of death and obtaining clinical improvement.
Keywords: SARS-Cov-2, COVID-19, vitamin C
is less effective
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