PMC:7335644 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7335644","sourcedb":"PMC","sourceid":"7335644","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7335644","text":"Reply: Vitamin C as a Possible Therapy for COVID-19\n\nDear Editor:\nWe appreciate the comment from Hemilä et al [1]. Previous studies based on in-vitro experiments have identified that high dosage intravenous Vit-C with copper and/or iron is virucidal [2]. However, despite these studies, the in-vivo virucidal activity of Vit-C has not been confirmed in detail. Previously, your meta-analyses of clinical trial data showed that regular Vit-C intake shortened the duration of the common cold by 8% [3]. However, coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus (severe acute respiratory syndrome coronavirus 2) whose genome sequence differs from other human coronaviruses causing the common cold [4]. Moreover, two recent clinical trials have demonstrated no significant difference in the development of sepsis, or severe acute respiratory failure, between Vit-C and non-Vit-C groups. In the CITRIS-ALI trial, no significant difference was found between the Vit-C (50 mg/kg every 6 hours for 96 hours) and placebo groups in the primary outcomes measured. These included modified Sequential Organ Failure Assessment score, C-reactive protein levels, and thrombomodulin levels at 168 hours. However, secondary outcome measures did differ between the groups with 28-day all-cause mortality significantly lower and intensive care unit-free days significantly shorter in the placebo groups than in the Vit-C groups [5]. The Vitamin C, hydrocortisone and thiamine in patients with septic shock (VITAMINS) trial also reported that among patients with septic shock, a combination of intravenous Vit-C, hydrocortisone, and thiamine did not significantly improve the primary outcome measure (duration of time alive and free of vasopressor administration over 7 days) compared with that after the intravenous hydrocortisone treatment alone [6].\nAlthough Vit-C generally exhibits low toxicity, taking \u003e2 g of Vit-C per day may cause adverse gastrointestinal events including abdominal pain, diarrhea, and/or nausea. Although Vit-C is a water-soluble vitamin, with excess excreted in the urine, it can contribute to the formation of renal stones [7]. Additionally, glucose-6-phosphate dehydrogenase (G6PD) deficiency, a genetic condition that results in inadequate G6PD levels, can cause hemolytic anemia following intravenous Vit-C treatment [8].\nCurrently, multiple clinical trials investigating the effect of Vit-C on severe COVID-19 are on going [9]. However, this therapy can only be considered, and therefore incorporated into treatment guidelines, based on sufficient confirmatory research results. For now, we will have to wait.\n\nConflict of Interest: No conflicts of interest.\nAuthor Contributions: Conceptualization: SBK, JSY.\nData curation: SBK, JSY.\nFormal analysis: SBK, JSY.\nInvestigation: SBK.\nMethodology: SBK.\nProject administration: JSY.\nResources: SBK.\nSoftware: SBK.\nSupervision: JSY.\nValidation: JSY.\nVisualization: SBK.\nWriting - original draft: SBK.\nWriting - review \u0026 editing: 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