Intravenous Vitamin C for Patients Hospitalized With COVID-19: Two Harmonized Randomized Clinical Trials
Among critically ill patients receiving organ support in ICU (90 sites) & non- critically ill patients (40 sites) in RCT terminated after statistical triggers for harm & futility were met, vitamin C had low probability of improving organ support–free days and hospital survival.
Source:
Journal of the American Medical Association
SPS commentary:
The median number of organ support–free days was 7 for the vitamin C vs 10 for control group (adjusted proportional OR, 0.88; 95% {CrI}, 0.73 to 1.06]) and posterior probabilities were 8.6% (efficacy), 91.4% (harm), and 99.9% (futility). Among non-critically ill patients, median number of organ support–free days was 22 vs 22, respectively (0.80; 0.60 to 1.01) and posterior probabilities were 2.9% (efficacy), 97.1% (harm), and greater than 99.9% (futility).
An editorial notes that these data from from the Lessening Organ Dysfunction with Vitamin C for COVID-19 (LOVIT-COVID) trial and the Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP) trial represent another in a growing list of RCTs failing to demonstrate a benefit with vitamin C for treating infection or sepsis. It adds that even more concerning is the possibility that vitamin C is detrimental in patients with COVID-19 because the probability of harm exceeded 90% for organ support–free days in both critically ill and non-critically ill patients. It highlights that whereas clinicians have minimal therapeutic options beyond antimicrobial therapy and supportive care in patients with bacterial sepsis, in patients hospitalized with COVID-19, there are numerous therapeutics that, depending on the stage of the disease, can target either the host response (e.g., corticosteroids, baricitinib, tocilizumab, infliximab, abatacept) or the virus (e.g., remdesivir). It concludes that “although the allure of vitamin C may continue to tempt clinicians, the results from the harmonized LOVIT-COVID and REMAP-CAP trials should lead clinicians to use therapies that have been demonstrated to be beneficial in patients with COVID-19 as opposed to one that is almost certainly ineffective and potentially harmful.”