Intended for healthcare professionals


Tom Nolan’s research reviews—23 June 2022

BMJ 2022; 377 doi: (Published 23 June 2022) Cite this as: BMJ 2022;377:o1509
  1. Tom Nolan, clinical editor; sessional GP, Surrey
  1. The BMJ, London

She sells C shells, but I’m not sure

Within a few seconds of typing “vitamin C infusion near me” into Google, I’m ready to book my high dose (40 g) vitamin C infusion for a bargain price of £230. It’s apparently indicated for people who have gastrointestinal issues, who suddenly feel run down, or who have to travel into the city or travel a lot (that is, pretty much everyone). These doctor-run clinics where you go and get a drip of your favourite vitamin seem quite popular these days. But how safe is intravenous vitamin C?

In a study that randomised 872 adults with sepsis receiving vasopressor therapy in an intensive care unit, those who received intravenous vitamin C had a higher risk of death or persistent organ dysfunction at 28 days than those who received placebo (risk ratio 1.21, P=0.01). This study population is very different from the general population, and patients in the study were given several doses of vitamin C, but the findings demonstrate that vitamins aren’t necessarily as harmless as we often assume.

N Engl J Med doi:10.1056/NEJMoa2200644

Pox pics

I expect there’s been a fair amount of googling of “monkeypox rash” over the past few months—both by the public and doctors. For a smoother—“I’m not really googling it, I’m just looking it up to double check”—consultation experience, we can now bookmark a case report that includes four images of monkeypox genital lesions. The patient had a macular rash and painful lymphadenopathy in the right inguinal area, which could easily be mistaken for some chafing, and two ulcerated lesions and several umbilicated pustules on the penis, which unmistakably look like they need an urgent specialist opinion.

N Engl J Med doi:10.1056/NEJMicm2206893

Remission rates in Crohn’s disease

The first randomised head-to-head trial of biologic therapies in Crohn’s disease has made the front cover of the Lancet. “The clinical remission rates were strikingly high for both biologics in this study,” reads the big quote. The trial enrolled 386 patients across 18 countries with moderate to severe Crohn’s disease. Ustekinumab was administered every eight weeks (with placebo injections fortnightly in between), and adalimumab administered every two weeks—with treatment in each group continuing for a year. At the end of the year, 65% and 61% of each respective arm of the study were in clinical remission, with no statistically significant difference between remission rates or risk of serious infections (2-3%). These response rates are better than in previous trials and may, say the authors, reflect a population with comparatively short disease duration versus previous studies, or the lack of a placebo group in a study with a symptom-based primary endpoint since all those recruited know they are getting an active treatment.

Lancet doi:10.1016/S0140-6736(22)00688-2

Quit while you’re ahead

The first placebo controlled trial of varenicline added to counselling on smoking cessation among African American adults found that those randomised to varenicline were three times more likely to be abstinent from smoking after 26 weeks. Of the 500 participants in the study based in Kansas City, half were light smokers and 86% smoked menthol cigarettes. The quit rates seem fairly decent: 15.7% in the varenicline group versus 6.5% in the placebo group. Participants were paid $20-50 for each follow-up visit, and, although payments were made irrespective of smoking status, I know that if it was me in the study I’d be trying extra hard to quit so as not to let the investigators down.

JAMA doi:10.1001/jama.2022.8274

A classic study of intravenous fluid treatment

One way to go down in academic history as having published a classic piece of research is to call your study CLASSIC (“conservative versus liberal approach to fluid therapy of septic shock in intensive care”—CLASSIC is in there somewhere). It compared a restrictive approach to intravenous fluid treatment versus usual care in patients in intensive care with septic shock. There was no difference in the primary outcome of 90 day mortality, or secondary outcomes such as renal failure. However, the difference in volume of fluids given between the two groups was less than expected (median 1798 mL (interquartile range 500-4366) v 3811 mL (1861-6762)), meaning that finding any difference in outcomes between the groups was unlikely.

N Engl J Med doi:10.1056/NEJMoa2202707


  • Competing interests: None declared

  • Provenance and peer review: Not commissioned, not peer reviewed.

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