High dose Vitamin C fails to improve organ dysfunction scores among patients with sepsis and ARDS: JAMA

The efficacy of vitamin C as a potential treatment for COVID-19 has been a subject of ongoing debate and research since the outbreak of the pandemic. A recent study aimed to shed light on whether vitamin C could lead to improved outcomes for patients hospitalized with COVID-19, but the results have raised questions about its effectiveness as it was found to have a low probability of improving the primary outcome.

The Research Design:

This study was a comprehensive endeavor, involving two carefully coordinated randomized clinical trials conducted across 130 sites on four different continents. It enrolled patients who were critically ill and required organ support in intensive care units, as well as patients who were not critically ill. The study's enrollment spanned from July 23, 2020, to July 15, 2022.

Treatment Approach:

Patients were randomly assigned to receive intravenous vitamin C or a control group that received either a placebo or no vitamin C. The treatment regimen involved administering doses every six hours for a total of 96 hours, allowing for a maximum of 16 doses.

Key Study Metrics:

The primary outcome of interest was a composite measure known as "organ support–free days." This measure calculated the number of days that patients were both alive and free from the need for respiratory and cardiovascular organ support in the intensive care unit for up to 21 days, in addition to survival to hospital discharge. The scale for this measure ranged from -1 organ support–free day (indicating in-hospital death) to 22 organ support–free days (indicating patients who survived without requiring organ support). The study employed a Bayesian cumulative logistic model for its analysis.

Study Findings:

The research faced an unexpected conclusion, as the enrollment was terminated before the intended endpoint due to statistical triggers indicating potential harm and futility.

Critically Ill Patients: In the group receiving vitamin C, the median number of organ support–free days was 7, while in the control group, it was 10. The analysis found an adjusted proportional odds ratio (OR) of 0.88, indicating that vitamin C did not offer significant benefit (posterior probabilities: 8.6% efficacy, 91.4% harm, and 99.9% futility). Survival to hospital discharge for critically ill patients was 61.9% in the vitamin C group and 64.6% in the control group (adjusted OR, 0.92; posterior probability for efficacy: 24.0%).

Patients Who Were Not Critically Ill: For this group, the median number of organ support–free days was 22 days in both the vitamin C and control groups. The adjusted proportional OR was 0.80, indicating that vitamin C did not significantly impact outcomes (posterior probabilities: 2.9% efficacy, 97.1% harm, and greater than 99.9% futility). Survival to hospital discharge was 85.1% in the vitamin C group and 86.6% in the control group (adjusted OR, 0.86; posterior probability for efficacy: 17.8%).

Conclusion:

In summary, the study's conclusion casts doubt on the utility of vitamin C as a treatment for COVID-19 in hospitalized patients. The findings suggest that vitamin C has a low probability of improving the primary composite outcome of organ support–free days and hospital survival. While vitamin C is known for its potential health benefits, its effectiveness in the context of COVID-19 remains uncertain, emphasizing the need for ongoing research and exploration of more effective treatment options. As the battle against COVID-19 continues, these findings contribute to the growing body of knowledge surrounding potential treatments for the virus.

For further reference log on to:

JAMA. Published online October 25, 2023. doi:10.1001/jama.2023.21407