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RECOVERY trial: the UK covid-19 study resetting expectations for clinical trials

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1626 (Published 28 April 2020) Cite this as: BMJ 2020;369:m1626

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Covid 19 and High-dose Vitamin C Re: RECOVERY trial: the UK covid-19 study resetting expectations for clinical trials

Dear Editor

Covid 19 and High-dose Vitamin C

The UK Recovery trial is reported to be the world’s biggest Covid-19 drug trial but does not seem to include use of Vitamin C. [1] In contrast, a high-dose vitamin C trial has been started in New Zealand following use in China as a safe and non-drug way to treat Covid 19 infection. [2]

Dr Richard Cheng writes that a quick, deployable and accessible, effective and safe treatment is urgently needed to save lives and curtail the spreading of Covid 19 infections. Significantly increased oxidative stress due to rapid release of free radicals and cytokines is the hallmark of acute respiratory distress syndrome (ARDS) which leads to cellular injury, organ failure and death. Early use of large dose antioxidants, such as VC can be an effective treatment for these patients. Clinical studies also show that high-dose oral VC provides certain protection against viral infections. Neither intravenous nor oral administration of high-dose VC is associated with significant side effects. [3] High-dose intravenous vitamin C (VC) was used successfully in the treatment of 50 moderate to severe COVID-19 patients. The doses used varied between 10 g and 20 g per day, given over a period of 8–10 h. Additional VC bolus can be required for patients in critical conditions. The oxygenation index improved in real time and all the patients were eventually cured and discharged. [4]

Just recently registered on clincialtrials.gov (Identifier: NCT04264533), a new clinical trial to investigate vitamin C infusion for the treatment of severe 2019-nCoV infected pneumonia has begun in Wuhan, China. This is one of the first RCTs to test the effects of IV vitamin C in patients infected with this virus. In this trial, the investigators will treat 140 patients with a placebo control or intravenous vitamin C at a dose of 24 g/day for 7 days. They will assess requirements for mechanical ventilation and vasopressor drugs, organ failure scores, ICU length of stay and 28-day mortality.

1 Wilkinson E. RECOVERY trial: the UK covid-19 study resetting expectations for clinical trials . BMJ 2020; 369: m1626 (Published 28 Apr 2020)
2 Carr AC. A new clinical trial to test high-dose vitamin C in patients with COVID-19. Crit Care. 2020; 24: 133.Published online 2020 Apr 7. doi: 10.1186/s13054-020-02851-4
3 Cheng R Z. Can early and high intravenous dose of vitamin C prevent and treat coronavirus disease 2019 (COVID-19)? Medicine in Drug Discovery, March 2020;5:100028.
4 Hernández A, Papadakos PJ, Torres A, González DA, Vives M, Ferrando C, Baeza J.Hernández A, et al.Rev Esp Anestesiol Reanim. Two known therapies could be usful as adjuvant therapy in critical patients infected by Covid-19. 2020 Apr 14:S0034-9356(20)30075-X. doi: 10.1016/j.redar.2020.03.004.

Competing interests: No competing interests

01 May 2020
Ellen CG Grant
Physician and medical gynaecologist
Retired
Kingston-upon-Thames, UK