A continuous publication, open access, peer-reviewed journal
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 1 of 29ISSN: 1740-4398
REVIEW
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) quickly became a global pandemic and has been responsible, so far, for infecting 5.8 million and claiming the lives of more than 350,000. While certain medications initially garnered attention as potential treatment options, further studies failed to demonstrate great promise but did demonstrate the need to reduce the cytokine storm experienced by patients with this potentially life-threatening virus. Unfortunately, there is no cure on the horizon, but members of the medical community are beginning to evaluate the potential role of vitamins and supplements as potential treatment options or addition to
other treatments. The goal of this narrative review is to evaluate current and ongoing clinical trials of vitamins and supplements, alone or in combination with each other or other therapies, for the treatment of coronavirus disease-2019 (COVID-19).
Keywords: coronavirus, COVID-19, SARS-COV-2, severe acute respiratory syndrome coronavirus, supplement, 2019-nCOV, 2019 novel coronavirus, vitamin.
CitationMichienzi SM, Badowski ME. Can vitamins and/or supplements provide hope against coronavirus? Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7
Sarah M Michienzi PharmD1, Melissa E Badowski PharmD1
1University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
Can vitamins and/or supplements provide hope against coronavirus?
ACCESS ONLINE
IntroductionSevere acute respiratory syndrome coronavirus-2 (SARS-COV-2), the cause of coronavirus disease-19 (COVID-19),1 was first reported to the World Health Organization (WHO) on December 31, 2019,2 and declared a global pandemic on March 11, 2020.3 To date, there are approximately 5.8 million confirmed cases and over 350,000 deaths globally.4 There are no Food and Drug Administration5 or European Medicines Agency6 approved vaccines or medications for the treatment of COVID-19. No specific therapies are recommended by the Centers for Disease Control and Prevention,7 Infectious Diseases Society of America,8 Society for Critical Care Medicine,9 or WHO10 outside of clinical trials. The National Institutes of Health (NIH)11 guideline was recently updated to recommend remdesivir in certain patients based on preliminary evidence from clinical trials.
Despite absence of guideline-supported recommendations, several therapies thought to be effective for COVID-19 are in use around the world. However, access to these treatments is not equitable among all populations.12 Remdesivir and chloroquine/hydroxychloroquine are drug therapies that have received the most attention.
Remdesivir was initially available through individual compassionate use requests. This pathway was halted for the
majority of patients due to the overwhelming numbers of requests and the need to focus on clinical trials. Remdesivir access was then limited to these clinical trials and expanded access programs.13 However, not all patients had the equal opportunity to enroll due to study site locations and eligibility criteria.14,15 It was only on May 1, 2020, that the FDA granted emergency use authorization (EUA) for remdesivir. It is now available for suspected or confirmed disease in hospitalized adults and children with severe disease, which is defined as low blood oxygen levels or needing oxygen therapy or mechanical ventilation.16 However, allocation of remdesivir through EUA has not been transparent, and fears grow as healthcare providers are faced with rationing the limited drug supply.17,18
Chloroquine and its metabolite hydroxychloroquine are widely prescribed for other indications. However, when reports emerged of their possible activity against SARS-COV-2, shortages quickly developed in the United States (US).19–21 These drugs can be obtained for COVID-19 treatment through the FDA EUA, but use is reserved for only the sickest patients in certain hospitals.22 Additionally, chloroquine and hydroxychloroquine are associated with potentially severe cardiac side effects.23 Furthermore, an early clinical trial failed to demonstrate efficacy.24
Another potential therapy showing promise is the 14-day combination of lopinavir, 400 mg, and ritonavir, 100 mg orally
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 2 of 29ISSN: 1740-4398
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every 12 h, ribavirin, 400 mg orally every 12 h, and three doses of 8 million international units of interferon beta-1b on alternate days when compared to 14 days of lopinavir, 400 mg, and ritonavir, 100 mg, every 12 h. This multicenter, prospective, open-label, randomized, phase 2 trial conducted at six sites in Hong Kong demonstrated that the triple antiviral therapy was safe and superior to lopinavir and ritonavir alone.25
Due to concerns over equitable access and adverse events of notable experimental treatments, we aimed to investigate potential alternative agents for treatment of COVID-19 that may have better availability and side effect profiles. Vitamins and essential nutrients are well known for their overall tolerability and requisite role in immune function. Thus, they were a natural choice for our investigation. This narrative review summarizes current and ongoing clinical trials of high-dose vitamins and supplements, alone or in combination with each other or other therapies, for the treatment of COVID-19. While not the focus of this review, vitamins and supplements may have an additional benefit in COVID-19 prevention, with a number of clinical trials planned to investigate this hypothesis. If shown to be safe and effective, vitamins and supplements may provide the much-needed answer to the COVID-19 pandemic.
MethodsThe authors searched the NIH US Library of Medicine Clinical Trials Database (www.clinicaltrials.gov) and the WHO’s International Clinical Trials Registry Platform (WHO ICTRP) via the NIH (https://clinicaltrials.gov/ct2/who_table). Prospective interventional trials of vitamins and/or supplements, excluding Chinese traditional medicine (CTM), for the treatment of COVID-19 posted on or before May 4, 2020, were included. Synonyms for COVID-19 were SARS-COV-2, 2019-nCOV, 2019 novel coronavirus, and SARS-COV-2. Additional search terms of ‘vitamin’ and ‘supplement’ were used to narrow search results. Traditionally, indexed literature and abstracts would have been added to the search methodology, but given the novelty of the subject, Medline and Embase searches for interventional studies yielded no results. This manuscript was exempted from ethics review as it did not involve human subjects.
ResultsIn the NIH COVID-19 database, the additional search terms of ‘vitamin’ yielded 28 studies and ‘supplement’ yielded 115 additional studies. Of these 143 studies, 18 met inclusion criteria from this database (Figure 1). Reasons for study exclusion were: erroneous search result (n=103); vitamin/supplement given as placebo, control, or standard of care (n=9), CTM (n=4); prevention study (n=5); diet plan as intervention (n=2; Ayurveda and ketogenic); and methodology (n=2; retrospective design and COVID-19 not required for inclusion).
Filtering the NIH’s WHO ICTRP COVID-19 study table using the terms ‘vitamin’ yielded 27 studies. Filtering by ‘supplement’
yielded 36 additional studies. Of those 63 studies, 12 met inclusion criteria from this database. Reasons for study exclusion were: erroneous search result (n=37), diagnostic study (n=3), cancelled by investigator (n=3), CTM (n=2), prevention study (n=4), retrospective design (n=1), and vitamin/supplement given as placebo, control, or standard of care (n=1). One trial was dual registered in the American and European databases, leaving 11 unique studies.
Of the two clinical trial registries searched, a total of 29 studies met inclusion for evaluation and focused on the role of fatty acids, honey, medicinal plant extracts, probiotics, vitamins A, B, C, and D, and zinc (Table 1). Although these studies are ongoing and enrolling subjects, it is important to understand the potential role of these supplements and vitamins (Table 2).
The vitamins and supplements are under investigation in these trials largely as a result of their anti-inflammatory and antioxidant properties.26–54 It is postulated that honey also has antiviral properties.34,35 Table 1 highlights the mechanism of action, commercial availability, common uses, considerations for adverse events and drug–drug interactions, and proposed use in COVID-19 for the vitamins and supplements.
Twelve studies in six countries seek to evaluate nutritional supplementation or supplements for the treatment of COVID-19.55–66 Agents evaluated in these studies are α-lipoic acid (ALA) (n=2),55,56 curcumin (n=1),57 Chlorella vulgaris (green algae) with a herbal tea blend (n=1),58 escin (n=1),59 honey (n=1),60 Imfluna (=1),61 n-acetyl cysteine (NAC) (n=2)62,63, fatty-acid/antioxidant-enriched oral supplement (n=1),64 probiotics (n=1),65 and resistant starch (n=1).66 Nineteen studies in eight countries seek to evaluate vitamins and minerals for the treatment of COVID-19.67–83 Agents evaluated in these studies are: vitamin A (n=3),67–69 vitamin B (n=2),69,70 vitamin C (n=10),69,71–78 vitamin D (n=8),64,69,77,79–83 and zinc (n=3).77,78 The sum of studies here is more than 29, as multiple agents are investigated in some trials. For each study, Table 2 provides the trial location, design, treatment arms, requirements for treatment, status, planned end date, and endpoints.
The majority of vitamin supplements in these trials are administered orally, although some are parenteral. ALA is administered parenterally in both studies,55,56 escin is administered parenterally in one arm of its study,59 NAC62 and vitamin B69 are administered parenterally in one study each, and vitamin C is administered parentally71–78 in all studies except one.69 Intervention and comparator arms vary across the trials.55–83 The intervention arms call for the study agent to be given alone, in combination with other study agents, or with standard of care. Comparator arms include other study agents (e.g. adalimumab), standard of care, and/or placebo. Standard of care is not described in all trails. It may only be defined as such or specific antivirals (e.g. hydroxychloroquine and azithromycin) may be listed. Study agents investigated in
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 3 of 29ISSN: 1740-4398
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combination in at least one arm of one study are: methylene blue plus vitamin C plus NAC,62 vitamin D plus NAC,63 and oxygen–ozone therapy plus probiotics,65 vitamins A, B, C, D, plus E,69 quintuple therapy of vitamins C and D plus zinc plus hydroxychloroquine and azithromycin,77 vitamin C plus zinc,78 vitamin D plus aspirin,81 and vitamin D plus zinc83
(n=1 for all).
There are a wide range of planned primary and secondary outcomes among the studies.55–83 Notable planned outcomes include disease progression or recovery, adverse events, mortality, change in symptoms, vitals, radiology, and/or laboratory inflammatory markers, and rate of, length of, or time to hospitalization or mechanical ventilation. The study expected to have peer-reviewed results earliest is of ALA plus standard of care in critically ill patients with COVID-19.56 The majority of the other trials are recruiting (n=15). This is followed
by not yet recruiting (n=11), enrolling (n=1), and recruitment compete (n=1).55,57–83
DiscussionAlthough the full potential of vitamins and herbal supplements have not been elucidated, various studies are underway to assess these agents as potential treatment options and/or additive therapies to current treatment choices that vary around the world as there is no definitive treatment at this point in time. Depending on the formulation, vitamins and herbal supplements are relatively affordable and accessible. Availability in certain markets may be limited as this novel virus has caused patients and providers to stockpile medications, vitamins, and supplements for later use without proven efficacy and unknown safety profiles at higher than normal doses,
Figure 1. Selection of studies.98
Records after duplicates removed(n = 205)
Records screened(n = 205)
Records excluded(n = 140)
Full-text articles assessedfor eligibility
(n = 65)
Full-text articles excluded(n = 36)
- Vitamin/supplement given as placebo, control, SC (n= 10)- CTM (n=6)- Prevention study (n=9)- Diagnostic study (n=3)- Canceled by investigator (n=3)- Diet plan as intervention (n=2)- Retrospective design (n=2)- CoVID-19 not required for inclusion (n=1)
Studies included inqualitative synthesis
(n = 29)
Records identi�ed throughNIH Clinical Trials Database
(n = 143)
Records identi�ed throughWHO ICTRP
(n = 63)
Incl
uded
Elig
ibili
tySc
reen
ing
Iden
ti�c
atio
n
CoVID-19 = coronavirus disease; CTM = Chinese Traditional Medicine; NIH = National Institutes of Health; SC = standardof care; WHO ICTRP: World Health Organization’s International Clinical Trials Registry Platform
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 4 of 29ISSN: 1740-4398
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Tabl
e 1.
Ch
arac
teri
stic
s of
vit
amin
s an
d su
pple
men
ts u
nder
inve
stig
atio
n fo
r SA
RS-C
oV-2
.
Nam
eM
OA
Com
mer
cial
pro
duct
Mos
t com
mon
use
(s)
Cons
ider
atio
ns a
nd u
sual
dos
ePr
opos
ed u
se in
CO
VID
-1955
–83
Nut
riti
onal
supp
lem
enta
tion
or s
uppl
emen
ts
Alp
ha-li
poic
aci
d26,2
7A
ntio
xida
ntYe
s–A
ging
ski
n–C
ogni
tive
impa
irmen
t/de
men
tia–D
iabe
tes
–Dia
betic
neu
ropa
thy
–Dys
lipid
emia
–Mul
tiple
scl
eros
is–W
eigh
t los
s
AE:
alle
rgic
reac
tion,
hy
pogl
ycem
ia, c
hang
es in
vis
ion
DD
I: ch
emot
hera
py, a
ntid
iabe
tics
Usu
al d
aily
dos
e: 1
50–1
800
mg
Ant
ioxi
dant
effe
cts
Dos
ing:
120
0 m
g/d
IV
Curc
umin
28,2
9A
ntio
xida
nt, a
nti-
infla
mm
ator
y;
activ
e po
lyph
enol
of
Cur
cum
a lo
nga
(turm
eric
)
Yes
–Infl
amm
ator
y co
nditi
ons
AE:
GI c
ompl
aint
s
DD
I: no
maj
or; c
autio
n w
ith:
alky
latin
g ag
ents
, ant
icoa
gula
nts,
an
tipla
tele
ts, a
ntid
iabe
tics
Usu
al d
aily
dos
e: 1
80 m
g–2.
5 g
Sym
ptom
impr
ovem
ent
Spec
ific
prod
uct u
nder
inve
stig
atio
n:
Sina
Curc
umin
Dos
ing:
40
mg
PO B
ID ×
2 w
ks, t
hen
daily
Chlo
rella
vul
garis
(F
resh
wat
er g
reen
al
gae)
30,3
1
Nut
rient
and
an
tioxi
dant
Yes
–Can
cer
–Liv
er d
isea
se–I
nfec
tions
–Ski
n ul
cera
tions
–Tox
icit
y (le
ad, m
ercu
ry)
–Agi
ng
AE:
GI c
ompl
aint
s,
fatig
ue, p
hoto
sens
itivi
ty,
thro
mbo
cyto
peni
a
DD
I: w
arfa
rin (h
igh
in v
itam
in K
)
Usu
al d
aily
dos
e: 6
00 m
g–2
g
Sym
ptom
impr
ovem
ent
Dos
ing:
300
mg
PO Q
ID w
ith
herb
al te
a bl
end
Esci
n32,3
3A
nti-i
nflam
mat
ory
and
vaso
cons
tric
tor;
trite
rpen
e sa
poni
n (a
ctiv
e co
mpo
und)
in
Aes
culu
s hi
ppoc
asta
num
(h
orse
che
stnu
t);
part
of p
lant
dic
tate
s us
e
Yes
–CVI
–Oth
er v
enou
s co
nditi
ons
–IBS
–Mal
aria
–Ecz
ema
–Ski
n ul
cers
AE:
diz
zine
ss, G
I com
plai
nts,
he
adac
he, p
rurit
us, c
alf s
pasm
s; ba
rk c
an b
e ne
phro
toxi
c
DD
I: no
maj
or; c
autio
n w
ith
antic
oagu
lant
s, a
ntip
late
lets
, an
tidia
betic
s
Usu
al d
aily
dos
e, C
VI: 1
00–1
50 m
g
Redu
ce c
ytok
ine-
med
iate
d lu
ng
dam
age
Dos
ing:
40
mg
PO T
ID
Nat
ural
hon
ey34
,35,
96A
ntiv
iral,
antit
ussi
ve,
and
antim
icro
bial
(d
ue to
hig
h os
mol
arit
y an
d co
ncen
trat
ion
of
H2O
2)
Yes
–Ant
imic
robi
al a
gent
(a
ntib
acte
rial,
antif
unga
l,
antiv
iral,
antim
ycob
acte
rial)
–Cou
gh c
ause
d by
URI
–T
opic
al w
ound
trea
tmen
ta
AE:
abd
omin
al p
ain,
nau
sea,
vo
miti
ng, h
yper
glyc
emia
with
la
rge
dose
s, b
otul
ism
(do
not u
se
in c
hild
ren
< 1
yo)
DD
I: no
neD
RI, a
dded
sug
ars:
<25
% o
f tot
al
ener
gy
Poss
ible
ant
ivira
l effe
cts
and
acut
e co
ugh
Dos
ing:
1 g
ram
/kg/
day
split
into
2–3
do
ses
(Con
tinue
d)
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 5 of 29ISSN: 1740-4398
REVIEW – Vitamins and/or supplements for coronavirus drugsincontext.com
Tabl
e 1.
(Con
tinue
d)
Nam
eM
OA
Com
mer
cial
pro
duct
Mos
t com
mon
use
(s)
Cons
ider
atio
ns a
nd u
sual
dos
ePr
opos
ed u
se in
CO
VID
-1955
–83
Imflu
na36
Not
repo
rted
Not
ava
ilabl
e in
US
Not
repo
rted
NR
Mix
ture
of m
edic
inal
pla
nt
extr
act p
owde
r man
ufac
ture
d by
Hom
aPha
rmed
Pha
rmac
eutic
al
Com
pany
; pro
pose
d M
OA
not
re
port
ed
Dos
ing:
500
mg
caps
ule
× 3
PO T
ID A
C
N-a
cety
l cys
tine
(NAC
)37,3
8A
ntio
xida
ntYe
s–A
PAP
pois
onin
ga
–Lun
g di
seas
esa
– Con
tras
t-in
duce
d ne
phro
path
y pr
even
tion
AE:
GI c
ompl
aint
s (>
with
PO
), CN
S eff
ects
; IV:
rash
, hyp
erse
nsiti
vity
DD
I: ni
trog
lyce
rine
(maj
or),
use
caut
ion:
ACE
-I, a
ntic
oagu
lant
s,
antip
late
lets
, chl
oroq
uine
b
Lab:
dec
reas
ed P
T
Usu
al d
ose,
APA
P po
ison
ing:
122
0 m
g/kg
PO
ove
r 72
h or
200
mg/
kg
IV o
ver 2
1 h
Ant
ioxi
dant
effe
cts
by s
uppo
rtin
g th
e sy
nthe
sis
of g
luta
thio
ne
Dos
e: 6
00 m
g PO
dai
ly; d
ose
not
prov
ided
IV
Ora
l nut
ritio
nal
supp
lem
ents
(O
NS)
39,4
0,96
Ant
i-infl
amm
ator
y an
d an
tioxi
dant
Yes
–Nut
ritio
n–W
eigh
t gai
nA
E: d
iarr
hea,
nau
sea,
blo
atin
g,
exha
ustio
n, in
crea
sed
puls
e
DD
I: flu
oroq
uino
lone
s
RDA
:Pr
otei
n: 5
6 g
(M),
46 g
(F)
Fat:
ND
Carb
ohyd
rate
: 130
g (M
or F
)Fa
tty
acid
s (A
I): 1
.6 g
(M),
1.1
g (F
)Se
leni
um: 5
5 µg
(M o
r F)
Als
o se
e ot
her t
able
ent
ries
UL:
Prot
ein:
NR
Fat:
NR
Carb
ohyd
rate
: NR
Fatt
y ac
ids:
3 g
(M o
r F)
Sele
nium
: 400
µg
(M o
r F)
Als
o se
e ot
her t
able
ent
ries
May
redu
ce th
e se
verit
y of
CO
VID
-19
by p
rese
rvin
g nu
triti
onal
sta
tus
Hig
h do
ses
of n
3-fa
tty
acid
s an
d an
tioxi
dant
vita
min
s m
ay a
ct a
s an
an
ti-in
flam
mat
ory
agen
t to
m
odul
ate
cyto
kine
pro
duct
ion
and
redu
ce d
amag
e to
the
lung
s fr
om
the
asso
ciat
ed c
ytok
ine
stor
m
Spec
ific
prod
uct u
nder
inve
stig
atio
n:
Oxe
pa (A
bbot
t Nut
ritio
n, A
bbot
t La
bora
torie
s); 1
4.8
g pr
otei
n, 2
2.2
g fa
t, 25
g c
arbo
hydr
ate,
355
kca
l, 1.
1 g
EPA
, 450
mg
DH
A, 9
50 m
g G
LA, 2
840
IU v
itam
in A
as
1.2
mg
β-ca
rote
ne, 2
05
mg
Vita
min
C, 7
5 IU
vita
min
E, 1
8 ug
Se
leni
um, a
nd 5
.7 m
g Zi
nc
Dos
e: 8
oz
PO e
very
AM
sep
arat
ed
from
mea
ls
(Con
tinue
d)
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 6 of 29ISSN: 1740-4398
REVIEW – Vitamins and/or supplements for coronavirus drugsincontext.com
Tabl
e 1.
(Con
tinue
d)
Nam
eM
OA
Com
mer
cial
pro
duct
Mos
t com
mon
use
(s)
Cons
ider
atio
ns a
nd u
sual
dos
ePr
opos
ed u
se in
CO
VID
-1955
–83
Prob
iotic
s41,4
2In
terf
ere
with
pa
thog
enic
ba
cter
ia g
row
th
(com
petit
ion)
, im
prov
e ba
rrie
r fu
nctio
n of
ep
ithel
ium
, and
im
mun
omod
ulat
ion
Yes
–GI d
isor
ders
–Moo
d di
sord
ers
AE:
GI u
pset
, inf
ectio
n
DD
I: no
con
cern
s
Usu
al d
aily
dos
e, S
ivom
ixx:
1–2
sa
chet
s
Rest
ore
mic
robi
al fl
ora
Spec
ific
prod
uct u
nder
inve
stig
atio
n:
Sivo
mix
x (S
trep
toco
ccus
ther
mop
hilu
s D
SM 3
2224
5, B
ifido
bact
eriu
m la
ctis
DSM
32
246,
Bifi
doba
cter
ium
lact
is D
SM 3
2247
, La
ctob
acill
us a
cido
philu
s DSM
322
41,
Lact
obac
illus
hel
vetic
us D
SM 3
2242
, La
ctob
acill
us p
arac
asei
DSM
322
43,
Lact
obac
illus
pla
ntar
um D
SM 3
2244
, La
ctob
acill
us b
revi
s DSM
279
61)
Dos
e: 6
sac
hets
PO
BID
Resi
stan
t sta
rch43
,44,
96In
crea
se b
utyr
ate
prod
uctio
n in
th
e co
lon;
type
de
term
ines
spe
cific
pr
oper
ties
Yes
–Im
prov
e gu
t hea
lth/m
icro
biot
a– I
mpr
ove
seru
m in
flam
mat
ory
biom
arke
rs
AE:
flat
ulen
ce
DD
I: no
con
cern
s
AI,
fiber
: 38
g (M
or F
)
UL:
NR
Ant
i-infl
amm
ator
y eff
ects
Dos
e: 2
tbsp
(~20
g) P
O d
aily
× 3
d, t
hen
BID
Vita
min
s & m
iner
als
Vita
min
A45
,46,
96Es
sent
ial f
at-s
olub
le
mic
ronu
trie
ntYe
s–D
efici
ency
–Vis
ion
cond
ition
s–I
nfec
tion
–Wou
nd h
ealin
g
AE:
hyp
ervi
tam
inos
is w
ith h
igh
dose
s, c
hron
ic u
se
DD
I: no
con
cern
s at
usu
al d
oses
RDA
: 900
µg
(M),
700
(F) µ
gc
UL:
300
0 µg
(M o
r F)c
Supp
lem
enta
tion
for r
educ
ed le
vels
du
ring
infe
ctio
n
Dos
e: 2
5,00
0-50
,000
IU P
O d
aily
Vita
min
B47
,48,
96Es
sent
ial w
ater
-so
lubl
e vi
tam
in; e
ach
has
own
spec
ific
prop
ertie
s
Yes
–Defi
cien
cy–M
ood
diso
rder
s–E
nerg
y–C
ell g
row
th
AE:
no
maj
or
DD
I: no
con
cern
s
RDA
:Th
iam
in: 1
.2 m
g (M
), 1.
1 m
g (F
)Ri
bofla
vin:
1.3
mg
(M),
1.1
mg
(F)
Nia
cin:
16
mg
(M),
14 m
g (F
)Py
ridox
ine:
1.3
mg
(M o
r F)
Pant
othe
nate
(AI):
5 m
g (M
or F
)Bi
otin
(AI):
30
µg (M
or F
)Fo
lic a
cid:
400
µg
(M o
r F)
Ant
i-infl
amm
ator
y eff
ects
Spec
ific
prod
ucts
und
er in
vest
igat
ion:
Nic
otin
amid
e (v
itam
in B
3)
Dos
e: 1
000
mg
PO d
aily
Solu
vit (
thia
min
e 3.
1 m
g, ri
bofla
vin
4.9
mg,
nic
otin
amid
e 40
mg,
pyr
idox
ine
4.9
mg,
pan
toth
enat
e 16
.5 m
g, a
scor
bate
11
3 m
g, b
iotin
60
mcg
, fol
ic a
cid
400
mcg
, cya
noco
bala
min
5 m
cg)
(Con
tinue
d)
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 7 of 29ISSN: 1740-4398
REVIEW – Vitamins and/or supplements for coronavirus drugsincontext.com
Tabl
e 1.
(Con
tinue
d)
Nam
eM
OA
Com
mer
cial
pro
duct
Mos
t com
mon
use
(s)
Cons
ider
atio
ns a
nd u
sual
dos
ePr
opos
ed u
se in
CO
VID
-1955
–83
Vita
min
B47
,48,
96
(con
tinue
d)U
L:Th
iam
in: N
DRi
bofla
vin:
ND
Nia
cin:
35
mg
(M o
r F)
Pyrid
oxin
e: 1
00 m
g (M
or F
)Pa
ntot
hena
te: N
DBi
otin
: ND
Folic
aci
d: 1
000
µg (M
or F
)
Dos
e: 1
am
pule
PO
dai
ly
Vita
min
C(a
scor
bic
acid
)49,5
0,96
Ant
ioxi
dant
and
en
zym
atic
cof
acto
rYe
s–D
efici
ency
/nut
ritio
na
–Can
cer p
reve
ntio
nd
–URI
–Agi
ng s
kin
–Sep
sis
–Wou
nd h
ealin
g
AE:
osm
otic
dia
rrhe
a, G
I ups
et
(hig
h PO
dos
es),
hem
olyt
ic a
nem
ia
if G
6PD
defi
cien
t
DD
I: no
maj
or; u
se c
autio
n:
estr
ogen
s, a
ntih
yper
lipid
emic
s
Lab:
fals
e BG
ele
vatio
n
RDA
: 90
mg
(M),
75 m
g (F
)
UL:
200
0 m
g (M
or F
)
Stim
ulat
es IF
N p
rodu
ctio
n, w
hich
su
pplie
s ly
mph
ocyt
e pr
olife
ratio
n an
d en
hanc
es n
eutr
ophi
l pha
gocy
tic
capa
bilit
y
Dos
e: w
ide
rang
e, g
iven
eith
er IV
and
PO
(Tab
le 2
)
Vita
min
D(c
alci
fero
l)50,5
1,96
Esse
ntia
l fat
-sol
uble
vi
tam
inYe
s–D
efici
ency
–Hyp
opar
athy
roid
ism
–Ost
eom
alac
ia–O
steo
poro
sis
–Ost
eopo
rosi
s pr
even
tiond
–Pso
riasi
s
AE:
into
xica
tion
with
exc
essi
ve
dose
s
DD
I: no
maj
or; u
se c
autio
n: C
YP
P450
3A
4 su
bstr
ates
RDA
: 15
µg (M
or F
)e
UL:
100
µg
(M o
r F)e
Imm
unom
odul
ator
y an
d in
duce
s se
cret
ion
of a
ntim
icro
bial
pep
tides
Dos
e: 2
5,00
0–40
0,00
0 IU
PO
dai
ly
Vita
min
E(to
coph
erol
)52,5
3,96
Fat-
solu
ble
vita
min
Yes
–Defi
cien
cy–C
VD–D
iabe
tes
–Dia
betic
com
plic
atio
ns–C
ance
r pre
vent
ion
–Inf
ectio
ns
AE:
GI u
pset
, hea
dach
e, b
lurr
ed
visi
on
DD
I: no
maj
or; u
se c
autio
n:
alky
latin
g ag
ents
, ant
icoa
gula
nts,
an
tipla
tele
ts, C
YP P
450
3A4
subs
trat
es, w
arfa
rin
RDA
: 15
mg
(M o
r F)f
UL:
100
0 m
g (M
or F
)f
Ant
ioxi
dant
and
imm
unom
odul
ator
y eff
ects
Dos
e: 3
00 IU
PO
dai
ly
(Con
tinue
d)
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 8 of 29ISSN: 1740-4398
REVIEW – Vitamins and/or supplements for coronavirus drugsincontext.com
Tabl
e 1.
(Con
tinue
d)
Nam
eM
OA
Com
mer
cial
pro
duct
Mos
t com
mon
use
(s)
Cons
ider
atio
ns a
nd u
sual
dos
ePr
opos
ed u
se in
CO
VID
-1955
–83
Zinc
50,5
4,96
Esse
ntia
l min
eral
Yes
–Defi
cien
cy–A
MD
–Inf
ectio
ns–W
ound
hea
ling
AE:
GI u
pset
, met
allic
tast
e
DD
I: no
maj
or; u
se c
autio
n:
antid
iabe
tics,
dru
gs s
usce
ptib
le to
ch
elat
ion
in th
e gu
t
RDA
: 11
mg
(M),
8 m
g (F
)
UL:
40
mg
(M o
r F)
Ant
ivira
l pro
pert
ies
and
esse
ntia
l for
im
mun
e fu
nctio
n
Dos
e: 1
5–30
mg
PO d
aily
a FDA
app
rove
d in
dica
tion;
b Dec
reas
ed e
ffect
; spe
cial
cau
tion
as th
is is
a p
ropo
sed
CoVI
D-1
9 tr
eatm
ent;
c 1 IU
= 0
.15
µg a
s RA
Es fo
r β-c
arot
ene
supp
lem
ent97
; d FD
A a
ppro
ved
qual
ified
hea
lth c
laim
; e 1 IU
= 0
.025
µg97
; f 1 IU
= 0
.69
µ g
for n
atur
al a
nd 0
.45
µg fo
r syn
thet
ic97
.
AC, a
fter
mea
ls; A
E, a
dver
se e
vent
; AI,
adeq
uate
inta
ke (u
sed
whe
n in
suffi
cien
t evi
denc
e to
cal
cula
te R
DA
); A
MD
, age
-rel
ated
mac
ular
deg
ener
atio
n; B
G, b
lood
glu
cose
; BID
, tw
ice
daily
; CN
S,
cent
ral n
ervo
us s
yste
m; C
VD, c
hron
ic v
ascu
lar d
isea
se; C
VI, c
hron
ic v
enou
s in
suffi
cien
cy; C
YP, c
ytoc
hrom
e; d
, day
s; D
DI,
drug
-dru
g in
tera
ctio
n; D
RI, d
ieta
ry re
fere
nce
inta
ke; F
, fem
ale;
FD
A,
US
Food
and
Dru
g A
dmin
istr
atio
n; G
I, ga
stro
inte
stin
al; G
LA, g
amm
a-lin
olen
ic a
cid;
H2O
2, h
ydro
gen
pero
xide
; hrs
, hou
rs; H
SV-1
, her
pes
sim
plex
viru
s 1;
IBS,
irrit
able
bow
el s
yndr
ome;
IM,
intr
amus
cula
r; IV
, int
rave
nous
; kg,
kilo
gram
; M, m
ale;
MO
A, m
echa
nism
of a
ctio
n; N
D, n
ot d
eter
min
able
; NIC
E, N
atio
nal I
nstit
ute
for H
ealth
and
Car
e Ex
celle
nce;
NO
S, n
itric
oxi
de s
ynth
ase;
N
R, n
ot re
port
ed; O
z, o
unce
s; PH
E, P
ublic
Hea
lth E
ngla
nd; P
O, o
ral;
PT, p
roth
rom
bin
time;
QID
, fou
r tim
es d
aily
; RA
E, re
tinol
act
ivit
y eq
uiva
lent
s; RD
A, r
ecom
men
ded
diet
ary
allo
wan
ce (n
on-
preg
nant
adu
lts 1
9-50
yo)
; TID
, thr
ee ti
mes
dai
ly; U
L, to
lera
ble
uppe
r int
ake
leve
l; U
RI, u
pper
resp
irato
ry in
fect
ion;
US,
Uni
ted
Stat
es; V
ZV, v
aric
ella
zos
ter v
irus;
wks
, wee
ks; y
o, y
ears
old
.
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 9 of 29ISSN: 1740-4398
REVIEW – Vitamins and/or supplements for coronavirus drugsincontext.com
Tabl
e 2.
Clin
ical
tria
ls o
f vit
amin
s an
d su
pple
men
ts u
nder
inve
stig
atio
n fo
r SA
RS-C
oV-2
.
Tria
l ID
and
titl
eLo
cati
onSt
udy
desi
gnTr
eatm
ent a
rms
(n)
Requ
irem
ents
for t
reat
men
t (in
clus
ion/
excl
usio
n)St
atus
;st
udy
end
date
Plan
ned
endp
oint
s(p
rim
ary/
seco
ndar
y)
Nut
riti
onal
supp
lem
enta
tion
or s
uppl
emen
ts a
nd h
oney
ChiC
TR20
0003
0471
55
Effica
cy a
nd s
afet
y of
lip
oic
acid
inje
ctio
n in
redu
cing
the
risk
of
prog
ress
ion
in c
omm
on
patie
nts
with
nov
el
coro
navi
rus
pneu
mon
ia
(CO
VID
-19)
Chin
aRa
ndom
ized
, si
ngle
-blin
d,
mul
ticen
ter
α-Li
poic
aci
d (A
LA)
inje
ctio
n, d
ose
not
prov
ided
(n=1
97)
Incl
usio
n•
18 to
75
yo•
Mild
pat
ient
s w
ith c
onfir
med
CO
VID
-19
Recr
uitin
g;
4/30
/20
Prim
ary
•
Prog
ress
ion
from
mild
to
criti
cal/s
ever
e
Rout
ine
ther
apy
(ada
limum
ab) +
pl
aceb
o (n
=197
)
Excl
usio
n•
Preg
nanc
y or
lact
atio
n•
Alle
rgy
or in
tole
ranc
e to
stu
dy d
rugs
•
Enro
lled
in o
ther
CO
VID
-19
clin
ical
tria
ls
Oth
er fo
ods
or d
rugs
with
ant
ioxi
dant
eff
ect (
e.g.
vita
min
C, v
itam
in E
)•
Oth
er s
erio
us li
fe-t
hrea
teni
ng d
isea
ses
(e.g
. can
cer)
Seco
ndar
y•
NEW
S Sc
ore
•
Hos
pita
lizat
ion
•
30-d
all-
caus
e m
orta
lity
•
Leve
ls o
f infl
amm
ator
y fa
ctor
s an
d ox
idat
ive
stre
ss
ChiC
TR20
0002
9851
56
A ra
ndom
ized
, sin
gle-
blin
d, g
roup
seq
uent
ial,
activ
e-co
ntro
lled
stud
y to
eva
luat
e th
e cl
inic
al
effica
cy a
nd s
afet
y of
α-L
ipoi
c ac
id fo
r cr
itica
lly il
l pat
ient
s w
ith
coro
navi
rus
dise
ase
2019
Chin
aRa
ndom
ized
, si
ngle
-blin
d,
sing
le c
ente
r
SC +
α-L
ipoi
c ac
id
1200
mg/
d IV
x 7
d
(n=
8)
Incl
usio
n•
Criti
cal i
llnes
s of
dia
gnos
ed C
OVI
D-1
9Co
mpl
eted
; re
sults
pen
ding
Prim
ary
•
SOFA
sco
re
SC +
pla
cebo
(equ
al
volu
me
salin
e in
fusi
on) x
7 d
(n=9
)
Excl
usio
n•
Part
icip
atio
n in
oth
er c
linic
al tr
ials
•
Preg
nant
or b
reas
tfee
ding
•
Life
-thr
eate
ning
dis
ease
s (e
.g. c
ance
r)•
Expe
cted
sur
viva
l tim
e <
24 h
•
Alle
rgy
or in
tole
ranc
e to
stu
dy d
rug
•
His
tory
of i
mm
une
syst
em o
r im
mun
e-re
late
d di
seas
es
Seco
ndar
y •
30-d
all-
caus
e m
orta
lity
IRC
T202
0040
8046
990N
157
Eval
uatio
n of
Si
naCu
rcum
in a
s a
com
plem
enta
ry th
erap
y in
mild
-to-
mod
erat
e CO
VID
-19:
An
open
labe
l no
n-ra
ndom
ized
clin
ical
tr
ial
Iran
Non
-ra
ndom
ized
, op
en la
bel,
para
llel g
roup
Sina
curc
umin
40
mg
2 ca
psul
es P
O
BID
x 2
wks
then
1
caps
ule
PO d
aily
x 2
w
ks (n
=30)
Incl
usio
n •
Mild
-to-
mod
erat
e CO
VID
-19
by
labo
rato
ry, r
adio
logi
c, o
r clin
ical
di
agno
sis
•
18–6
5 yo
Not
yet
re
crui
ting;
9/
20/2
0
Prim
ary
•
Trea
tmen
t res
pons
e (fe
ver,
sym
ptom
s,
radi
olog
ic)
•
AEs
SC (n
=30)
Excl
usio
n •
< 7
d fr
om s
ympt
om s
tart
•
Preg
nanc
y or
lact
atio
n•
Alle
rgy
to s
tudy
dru
g•
Conc
omita
nt b
acte
rial i
nfec
tion
•
SpO
2 <
90%
•
< 5
ciga
rett
es/d
•
Sele
cted
pas
t med
ical
dis
ease
s
Seco
ndar
y •
LOS
hosp
ital
•
Clin
ical
out
com
es
(Con
tinue
d)
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 10 of 29ISSN: 1740-4398
REVIEW – Vitamins and/or supplements for coronavirus drugsincontext.com
Tabl
e 2.
(Con
tinue
d)
Tria
l ID
and
titl
eLo
cati
onSt
udy
desi
gnTr
eatm
ent a
rms
(n)
Requ
irem
ents
for t
reat
men
t (in
clus
ion/
excl
usio
n)St
atus
;st
udy
end
date
Plan
ned
endp
oint
s(p
rim
ary/
seco
ndar
y)
IRC
T201
5122
8025
732N
5158
Effec
t of A
lgom
ed, M
enta
lo
ngifo
lia, C
ham
omile
, Al
thae
a ro
sea,
Mal
va
sylv
estr
is, a
nd L
epid
ium
sa
tivum
sup
plem
ents
on
the
seve
rity
and
cons
eque
nces
of
coro
navi
rus
19 d
isea
se
(CO
VID
-19)
Iran
Non
-ra
ndom
ized
, pa
ralle
l co
ntro
l gro
up,
sing
le c
ente
r
SC +
C. v
ulga
ris 3
00
mg
supp
lem
ente
d w
ith h
erba
l tea
(2
g Pe
nnyr
oyal
; 2 g
Ch
amom
ile, 1
.4 g
H
olly
hock
s, a
nd 0
.6 g
M
allo
w) P
O Q
ID (n
=30)
Excl
usio
n•
Mal
igna
nt d
isea
ses
•
Seve
re re
nal,
liver
, and
hea
rt fa
ilure
•
Ant
icoa
gula
nts
•
Preg
nanc
y or
lact
atin
g
Recr
uitin
g;
6/16
/20
Prim
ary
•
Clin
ical
sym
ptom
s
SC
(n=3
0)Se
cond
ary
•
Non
e re
port
ed
NC
T043
2234
459
Effica
cy a
nd s
afet
y of
esc
in
as a
dd-o
n tr
eatm
ent i
n CO
VID
-19
infe
cted
pat
ient
s
Italy
Non
-ra
ndom
ized
, do
uble
-blin
d,
para
llel
assi
gnm
ent
SC (a
ntiv
iral t
hera
py) +
Es
cin
tabl
et 4
0 m
g PO
TI
D x
12
d (n
=40
)
Incl
usio
n•
18–7
5 yo
•
COVI
D-1
9 po
sitiv
e sc
reen
ing
test
in
mol
ecul
ar b
iolo
gy•
In e
scin
gro
up: l
ow re
spon
se to
st
anda
rd tr
eatm
ent
Recr
uitin
g;
6/30
/20
Prim
ary
•
All-
caus
e m
orta
lity
•
Clin
ical
sta
tus
SC (a
ntiv
iral t
hera
py) +
so
dium
esc
inat
e 20
mg
IV/d
x 1
2 d
(n=
40)
Excl
usio
n•
Preg
nant
or b
reas
tfee
ding
•
Alle
rgy/
con
trai
ndic
atio
n to
esc
in•
Any
con
ditio
n in
appr
opria
te fo
r st
udy
per i
nves
tigat
ors
•
Una
ble
to ta
ke o
ral m
edic
atio
ns
Seco
ndar
y •
Diff
eren
ces
in O
2 in
take
m
etho
ds•
LOS
in h
ospi
tal a
nd/o
r ICU
•
Pulm
onar
y fu
nctio
nSC
(ant
ivira
l the
rapy
) (n
=40
)
NC
T043
2334
560
The
effica
cy o
f nat
ural
ho
ney
in p
atie
nts
infe
cted
w
ith n
ovel
cor
onav
irus
(CO
VID
-19)
: A ra
ndom
ized
, co
ntro
lled,
sin
gle
mas
ked,
in
vest
igat
or in
itiat
ed,
mul
ti-ce
nter
tria
l
Egyp
tRa
ndom
ized
, m
ultic
ente
r, co
ntro
lled,
ph
ase
3
Hon
ey 1
g/k
g/d
PO
or N
GT
divi
ded
into
2–
3 do
ses
x 14
d +
SC
(sup
port
ive
mea
sure
s an
d LP
V/r,
umife
novi
r, ch
loro
quin
e,
hydr
oxyc
hlor
oqui
ne, o
r os
elta
miv
ir w
/ or w
/o
azith
rom
ycin
) (n=
500)
Incl
usio
n•
Dia
gnos
is o
f CO
VID
-19
(clin
ical
ly o
r co
nfirm
ed b
y sw
ab)
•
5–75
yo
Recr
uitin
g;
12/1
5/20
Prim
ary
•
14-d
reco
very
from
po
sitiv
e to
neg
ativ
e sw
abs
•
14-d
feve
r rec
over
y•
30-d
lung
CT
or X
-ray
re
solu
tion
SC (s
ee a
bove
) (n=
500)
Excl
usio
n•
Seve
rely
ill w
ith te
rmin
al d
isea
se•
NPO
pat
ient
s w
ith c
ontr
aind
icat
ion
to N
GT
feed
ing
Seco
ndar
y •
30-d
mor
talit
y •
Tim
e to
neg
ativ
e sw
ab
(30
d)
(Con
tinue
d)
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 11 of 29ISSN: 1740-4398
REVIEW – Vitamins and/or supplements for coronavirus drugsincontext.com
Tabl
e 2.
(Con
tinue
d)
Tria
l ID
and
titl
eLo
cati
onSt
udy
desi
gnTr
eatm
ent a
rms
(n)
Requ
irem
ents
for t
reat
men
t (in
clus
ion/
excl
usio
n)St
atus
;st
udy
end
date
Plan
ned
endp
oint
s(p
rim
ary/
seco
ndar
y)
IRC
T200
8090
1001
157N
1661
Eval
uatio
n of
the
effec
t of
IMFL
UN
A h
erba
l co
mpo
und
on th
e im
prov
emen
t of C
OVI
D-1
9 pn
eum
onia
sym
ptom
s in
pat
ient
s re
ferr
ed to
Ba
qiya
talla
h H
ospi
tal
Iran
Rand
omiz
ed,
doub
le-b
lind,
ph
ase
2,
plac
ebo-
cont
rolle
d,
clin
ical
tria
l
500
mg
caps
ules
x 2
of
her
bal c
ompo
und
(mix
ture
of m
edic
inal
pl
ant e
xtra
ct p
owde
r m
anuf
actu
red
by
Hom
aPha
rmed
Ph
arm
aceu
tical
Co
mpa
ny) P
O T
ID A
C x
2 w
ks +
SC
(n=3
0)
Incl
usio
n•
Sym
ptom
atic
CO
VID
-19
pneu
mon
ia
confi
rmed
with
che
st C
T an
d PC
R•
20–7
0 yo
•
Abl
e to
take
ora
l med
icat
ion
Recr
uitin
g;
6/14
/20
Prim
ary
•
SpO
2•
Resp
irato
ry ra
te•
Lung
infla
mm
atio
n (C
T sc
an)
SC +
pla
cebo
(n=3
0)Ex
clus
ion
•
Seve
re d
yspn
ea o
r res
pira
tory
failu
re
requ
iring
mec
hani
cal v
entil
atio
n or
ho
spita
lizat
ion
in IC
Us
•
Trea
tmen
t-re
sist
ant h
ypox
emia
or
thos
e w
ith s
ever
e un
derly
ing
dise
ase
•
Redu
ced
leve
l of c
onsc
ious
ness
or
need
of h
ospi
taliz
atio
n in
ICU
s •
Swal
low
ing
diso
rder
s or
pos
sibl
e as
pira
tion
•
Una
ble
to ta
ke o
ral m
edic
atio
ns•
Org
an tr
ansp
lant
atio
n•
Mal
igna
nt d
isea
se•
Cort
icos
tero
id o
r che
mot
hera
py
trea
tmen
t•
Unc
ontr
olle
d bl
ood
pres
sure
, un
cont
rolle
d di
abet
es, c
ardi
ovas
cula
r di
seas
e an
d un
derly
ing
resp
irato
ry
dise
ase
•
Preg
nant
wom
en
Seco
ndar
y •
Labo
rato
ry
infla
mm
ator
y m
arke
rs•
Coug
h an
d fe
ver
NC
T043
2322
864
Ant
i-infl
amm
ator
y/an
tioxi
dant
ora
l nut
ritio
n su
pple
men
tatio
n in
CO
VID
-19
(ON
SCO
VID
19)
Saud
i A
rabi
aD
oubl
e-bl
ind,
pr
ospe
ctiv
e,
sing
le c
ente
r, ra
ndom
ized
co
ntro
lled
tria
l
Oxe
pa (E
PA, G
LA,
antio
xida
nt O
NS)
8
oz P
O d
aily
in A
M
sepa
rate
d fr
om m
eals
(n
=15)
Incl
usio
n•
Confi
rmed
SA
RS-C
oV-2
infe
ctio
n•
COVI
D-1
9 pa
tient
in s
tabl
e co
nditi
on
(i.e.
not
requ
iring
ICU
adm
issi
on)
•
18–6
5 yo
Not
yet
re
crui
ting;
10
/1/2
0
Prim
ary
•
Labo
rato
ry
infla
mm
ator
y an
d nu
triti
onal
mar
kers (C
ontin
ued)
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 12 of 29ISSN: 1740-4398
REVIEW – Vitamins and/or supplements for coronavirus drugsincontext.com
Tabl
e 2.
(Con
tinue
d)
Tria
l ID
and
titl
eLo
cati
onSt
udy
desi
gnTr
eatm
ent a
rms
(n)
Requ
irem
ents
for t
reat
men
t (in
clus
ion/
excl
usio
n)St
atus
;st
udy
end
date
Plan
ned
endp
oint
s(p
rim
ary/
seco
ndar
y)
Isoc
alor
ic-
ison
itrog
enou
s pl
aceb
o (n
=15)
Sam
e m
anuf
actu
rer,
mac
ronu
trie
nt
com
posi
tion,
and
ca
lorie
den
sity
, and
no
rmal
con
cent
ratio
ns
of v
itam
in A
, C, E
, se
leni
um a
nd z
inc
Excl
usio
n•
Tube
feed
ing
or P
N•
Preg
nant
or l
acta
ting
•
Adm
issi
on to
ICU
> 2
4 hr
s•
Part
icip
atio
n in
ano
ther
stu
dy
incl
udin
g an
y su
pple
men
tatio
n or
di
seas
e sp
ecifi
c O
NS
Seco
ndar
y •
Ant
hrop
omet
rics
•
Tem
pera
ture
•
SpO
2•
WBC
cou
nts
NC
T043
6608
965
Oxy
gen–
ozon
e as
adj
uvan
t tr
eatm
ent i
n ea
rly c
ontr
ol
of C
OVI
D-1
9 pr
ogre
ssio
n an
d m
odul
atio
n of
th
e gu
t mic
robi
al fl
ora
(PRO
BIO
ZOVI
D)
Italy
Inte
rven
tiona
l, op
en-la
bel,
rand
omiz
ed,
para
llel
assi
gnm
ent
Oxy
gen-
ozon
e th
erap
y BI
D +
Siv
oMix
x (2
00
billi
on) p
robi
otic
su
pple
men
tatio
n, 6
sa
chet
s BI
D x
7 d
+
SC (a
zith
rom
ycin
+
hydr
oxyc
hlor
oqui
ne)
(n=7
6)
Incl
usio
n•
> 18
yo
•
Nas
opha
ryng
eal s
wab
CO
VID
-19
posi
tive
•
COVI
D-1
9 st
ages
I-II-
III•
Hos
pita
lized
(non
-ICU
)
Recr
uitin
g;
12/3
1/20
Pr
imar
y•
Intu
batio
n
SC (a
zith
rom
ycin
+
hydr
oxyc
hlor
oqui
ne)
(n=7
6)
Excl
usio
n•
COVI
D-1
9 st
ages
IV-V
-VI
•
ICU
•
Preg
nanc
y•
G6P
D d
efici
ency
•
Cont
rain
dica
tions
to th
erap
y•
Hyp
er-h
omoc
yste
inem
ia•
Favi
sm o
r thy
roid
itis
•
Coag
ulop
athi
es•
Neu
rove
geta
tive
dise
ases
•
Ang
ina
Seco
ndar
y•
Mor
talit
y•
LOS
hosp
ital
•
Labo
rato
ry
infla
mm
ator
y m
arke
rs
NC
T043
4268
966
The
role
of r
esis
tant
sta
rch
in C
OVI
D-1
9 in
fect
ion
Uni
ted
Stat
esM
ultic
ente
r, ra
ndom
ized
, bl
inde
d,
phas
e 3
Resi
stan
t sta
rch
2 tb
sp
(~ 2
0 g)
PO
dai
ly x
3 d
th
en P
O B
ID th
roug
h 14
d (n
=750
)
Incl
usio
n•
Age
> 1
8 ye
ars
•
COVI
D-p
ositi
ve s
tatu
s•
Mon
itore
d in
an
outp
atie
nt s
ettin
g at
a
stud
y in
stitu
tion
Not
yet
re
crui
ting;
5/
1/21
Prim
ary
•
Hos
pita
lizat
ion
for
COVI
D-1
9 co
mpl
icat
ion
(Con
tinue
d)
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 13 of 29ISSN: 1740-4398
REVIEW – Vitamins and/or supplements for coronavirus drugsincontext.com
Tabl
e 2.
(Con
tinue
d)
Tria
l ID
and
titl
eLo
cati
onSt
udy
desi
gnTr
eatm
ent a
rms
(n)
Requ
irem
ents
for t
reat
men
t (in
clus
ion/
excl
usio
n)St
atus
;st
udy
end
date
Plan
ned
endp
oint
s(p
rim
ary/
seco
ndar
y)
Plac
ebo
star
ch 2
tbsp
(~
20
g) P
O d
aily
x 3
d
then
PO
BID
thro
ugh
14 d
(n=7
50)
Excl
usio
n•
IBD
•
His
tory
of g
astr
ic b
ypas
s su
rger
y•
Act
ive
CDI
•
Act
ive
part
icip
atio
n in
ano
ther
CO
VID
-19
inte
rven
tiona
l tria
l•
Cond
ition
that
wou
ld p
ose
unac
cept
able
risk
to th
e pa
tient
or
rais
e co
ncer
n fo
r com
plia
nce
•
Star
ch a
llerg
y•
Diffi
culty
sw
allo
win
g •
Curr
ently
taki
ng a
ny IL
-6 in
hibi
tors
Seco
ndar
y •
Tim
e to
clin
ical
reco
very
•
Sym
ptom
sev
erity
sco
re
Vita
min
A
IRC
T201
7011
7032
004N
367
Eval
uatio
n of
the
effec
t of
vita
min
A o
n re
spira
tory
si
gns
and
hosp
italiz
atio
n in
pa
tient
s w
ith C
OVI
D-1
9
Iran
Two
arm
, pa
ralle
l gro
up
rand
omiz
ed,
cont
rolle
d
SC +
vita
min
A 5
0,00
0 IU
dai
ly x
2 w
ks (n
=15)
Incl
usio
n•
> 18
yo
•
Confi
rmed
dia
gnos
is o
f CO
VID
-19
with
RT
-PCR
•
Hos
pita
lized
, ven
tilat
or-in
depe
nden
t pa
tient
s
Recr
uitin
g;
7/20
/20
Prim
ary
•
LO
S ho
spita
lizat
ion
SC x
2 w
ks (n
=15)
Excl
usio
n•
Preg
nant
or l
acta
ting
•
Hig
h-do
se v
itam
in A
use
in la
st m
o
Seco
ndar
y •
Resp
irato
ry s
igns
IRC
T201
8052
0039
738N
268
Com
paris
on o
f the
eff
ectiv
enes
s of
sta
ndar
d tr
eatm
ent w
ith s
tand
ard
trea
tmen
t plu
s vi
tam
in A
in
trea
tmen
t in
COVI
D-1
9 pa
tient
s
Iran
Rand
omiz
ed,
cont
rolle
d,
doub
le-
blin
ded
SC +
vita
min
A 2
5,00
0 IU
/d x
10
d (n
=70)
Incl
usio
n•
1–75
yo
•
COVI
D-1
9 di
agno
sis
Recr
uitm
ent
com
plet
e;
resu
lts p
endi
ng
Prim
ary
•
Vita
l sig
ns•
Labo
rato
ry in
flam
mat
ory
mar
kers
SC +
pla
cebo
(n=7
0)Ex
clus
ion
•
Preg
nant
or l
acta
ting
wom
en•
Auto
imm
une
dise
ases
(lup
us, M
S, e
tc.)
•
Hep
atiti
s B
or C
•
Use
of v
itam
in A
•
Chro
nic
rena
l, liv
er, o
r hea
rt fa
ilure
•
COPD
Seco
ndar
y •
Non
e re
port
ed
(Con
tinue
d)
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 14 of 29ISSN: 1740-4398
REVIEW – Vitamins and/or supplements for coronavirus drugsincontext.com
Tabl
e 2.
(Con
tinue
d)
Tria
l ID
and
titl
eLo
cati
onSt
udy
desi
gnTr
eatm
ent a
rms
(n)
Requ
irem
ents
for t
reat
men
t (in
clus
ion/
excl
usio
n)St
atus
;st
udy
end
date
Plan
ned
endp
oint
s(p
rim
ary/
seco
ndar
y)
Vita
min
B
DRK
S000
2121
470
Impr
ovem
ent o
f the
nu
triti
onal
sta
tus
rega
rdin
g ni
cotin
amid
e (v
itam
in B
3) a
nd th
e co
urse
of C
OVI
D-1
9 di
seas
e (C
OVi
t)
Ger
man
yRa
ndom
ized
, pa
ralle
l gro
up,
blin
ded,
pl
aceb
o-co
ntro
lled,
si
ngle
-cen
ter
Nic
otin
amid
e 10
00
mg
(500
mg
x 2
tabl
ets)
PO
dai
ly x
4
wks
(n=
650)
Incl
usio
n•
> 18
yo
•
Confi
rmed
SA
RS-C
oV-2
infe
ctio
n•
Resp
irato
ry s
ympt
oms
Recr
uitm
ent
plan
ned;
not
pr
ovid
ed
Prim
ary
•
Hos
pita
lizat
ion
w/ c
ontin
uous
O2
requ
irem
ent >
24
hSe
cond
ary
•
Vent
ilatio
n•
Mor
talit
y•
ER v
isits
•
ICU
sta
ys•
Reso
lutio
n of
sym
ptom
s•
Seve
rity
impr
ovem
ent
Plac
ebo
silic
a 24
5 m
g PO
dai
ly x
4 w
ks
(n=
650)
Vita
min
C
NC
T042
6453
371
Vita
min
C In
fusi
on fo
r th
e tr
eatm
ent o
f sev
ere
2019
-nCo
V in
fect
ed
pneu
mon
ia
Chin
aRa
ndom
ized
, pa
ralle
l-as
sign
men
t, bl
inde
d,
plac
ebo-
cont
rolle
d,
sing
le-c
ente
r
Vita
min
C 1
2 g
IV B
ID
x 7
d (in
fusi
on ra
te 1
2 m
L/hr
) (n=
70)
Incl
usio
n•
> 18
yo
•
Dia
gnos
ed w
ith s
erio
us o
r crit
ical
CO
VID
-19
•
Rece
ivin
g tr
eatm
ent i
n IC
U
Recr
uitin
g;
9/30
/20
Prim
ary
•
Vent
ilato
r-fr
ee d
Plac
ebo
ster
ile w
ater
50
mL
IV B
ID x
7 d
(in
fusi
on ra
te 1
2 m
L/hr
) (n=
70)
Excl
usio
n•
Vita
min
C a
llerg
y•
Dys
pnea
due
to c
ardi
ogen
ic
pulm
onar
y ed
ema
•
Preg
nant
or b
reas
tfee
ding
•
Life
exp
ecta
ncy
<24
h•
Trac
heot
omy
or h
ome
O2
ther
apy
requ
irem
ent
•
Prev
ious
ly c
ompl
icat
ed w
ith
end-
stag
e lu
ng d
isea
se, e
nd-
stag
e m
alig
nanc
y, G
6PD
, dia
betic
ke
toac
idos
is, a
nd a
ctiv
e ki
dney
st
one
dise
ase
•
Sim
ulta
neou
s pa
rtic
ipat
ion
in
anot
her c
linic
al tr
ial
Seco
ndar
y •
28-d
mor
talit
y•
LOS
ICU
•
Nee
d fo
r CPR
•
Vaso
pres
sor d
ays
•
Vent
ilato
r par
amet
ers
•
APA
CHE
II an
d SO
FA s
core
s
(Con
tinue
d)
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 15 of 29ISSN: 1740-4398
REVIEW – Vitamins and/or supplements for coronavirus drugsincontext.com
Tabl
e 2.
(Con
tinue
d)
Tria
l ID
and
titl
eLo
cati
onSt
udy
desi
gnTr
eatm
ent a
rms
(n)
Requ
irem
ents
for t
reat
men
t (in
clus
ion/
excl
usio
n)St
atus
;st
udy
end
date
Plan
ned
endp
oint
s(p
rim
ary/
seco
ndar
y)
NC
T043
2351
472
Use
of a
scor
bic
acid
in
patie
nts
with
CO
VID
19
Italy
Ope
n la
bel,
long
itudi
nal
Vita
min
C 1
0 g
IV +
SC
(n=5
00)
Incl
usio
n•
In c
ase
of d
oubt
of i
nter
stiti
al
pneu
mon
ia w
ith in
dica
tions
for
intu
batio
n•
Posi
tive
swab
test
of S
ARS
-CoV
-2•
Inte
rstit
ial p
neum
onia
Recr
uitin
g;
3/13
/21
Prim
ary
•
In-h
ospi
tal m
orta
lity
Excl
usio
n•
Neg
ativ
e sw
ab fo
r SA
RS-C
oV-2
Seco
ndar
y •
PCR
leve
ls•
Lact
ate
•
LOS
hosp
ital
•
Sym
ptom
s an
d re
solu
tion
of s
ympt
oms
(feve
r, co
ugh,
sho
rtne
ss
of b
reat
h, o
r diffi
culty
br
eath
ing)
•
Posi
tive
COVI
D-1
9 sw
ab•
Dur
atio
n of
pos
itive
CO
VID
-19
swab
•
Tom
ogra
phy
imag
ing
NC
T043
4418
473
Early
infu
sion
of v
itam
in
C fo
r tre
atm
ent o
f nov
el
coro
navi
rus
acut
e lu
ng
inju
ry (E
VIC
T-CO
RON
A-A
LI)
Uni
ted
Stat
esPh
ase
II,
rand
omiz
ed,
blin
ded,
pl
aceb
o-co
ntro
lled
L-as
corb
ic a
cid
100
mg/
kg IV
q8
hrs
x 72
hr
s m
ax (n
=100
)
Incl
usio
n•
>18
yo•
Hos
pita
lized
pat
ient
s di
agno
sed
with
CO
VID
-19
base
d on
pos
itive
RT-
PCR
with
hyp
oxem
ia•
New
SpO
2 <9
3% o
n ro
om a
ir or
new
re
quire
men
t of s
uppl
emen
tal O
2•
Any
incr
ease
in re
quire
men
t of
supp
lem
enta
l O2
in p
atie
nts
requ
iring
ho
me
O2
Not
yet
re
crui
ting;
May
20
21
Prim
ary
•
Num
ber o
f ven
tilat
or-
free
day
s
Plac
ebo
dext
rose
5%
w
ater
IV (n
=100
)Ex
clus
ion
•
Vita
min
C a
llerg
y•
Pres
ence
of d
iabe
tic k
etoa
cido
sis
•
Act
ive
kidn
ey s
tone
s•
Preg
nant
•
Inca
rcer
ated
Seco
ndar
y •
All-
caus
e-m
orta
lity
•
Acu
te in
flam
mat
ion-
free
day
s•
Org
an-f
ailu
re-f
ree
days
(Con
tinue
d)
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 16 of 29ISSN: 1740-4398
REVIEW – Vitamins and/or supplements for coronavirus drugsincontext.com
Tabl
e 2.
(Con
tinue
d)
Tria
l ID
and
titl
eLo
cati
onSt
udy
desi
gnTr
eatm
ent a
rms
(n)
Requ
irem
ents
for t
reat
men
t (in
clus
ion/
excl
usio
n)St
atus
;st
udy
end
date
Plan
ned
endp
oint
s(p
rim
ary/
seco
ndar
y)
NC
T043
5778
274
Adm
inis
trat
ion
of
intr
aven
ous
vita
min
C
in n
ovel
cor
onav
irus
infe
ctio
n an
d de
crea
sed
oxyg
enat
ion
(AVo
CaD
O):
A p
hase
I/II
safe
ty, t
oler
abili
ty, a
nd
effica
cy c
linic
al tr
ial
Uni
ted
Stat
esSi
ngle
-cen
ter,
open
-labe
lL-
asco
rbic
aci
d 50
m
g/kg
IV q
6 hr
s x
4 d
(16
dose
s) (n
=20)
Incl
usio
n•
18–9
9 yo
•
Hos
pita
lized
pat
ient
s di
agno
sed
with
CO
VID
-19
base
d on
pos
itive
RT-
PCR
•
Mild
deo
xyge
natio
n S/
F ra
tio d
ecre
ased
by
25%
from
bas
elin
e on
adm
issi
on, o
r SpO
2 <9
5% o
n ro
om a
ir•
Non
-chi
ldbe
arin
g po
tent
ial o
r chi
ldbe
arin
g po
tent
ial w
ith a
neg
ativ
e pr
egna
ncy
test
at
scre
enin
g, a
nd u
sing
a re
liabl
e m
etho
d of
co
ntra
cept
ion
Recr
uitin
g;
8/1/
20Pr
imar
y •
Inci
denc
e of
adv
erse
ev
ents
•
Inci
denc
e of
ser
ious
ad
vers
e ev
ents
•
Inci
denc
e of
adv
erse
re
actio
ns
Excl
usio
n•
Vita
min
C a
llerg
y•
Stag
e IV
or a
bove
CKD
•
Pres
ence
of d
iabe
tic k
etoa
cido
sis,
use
of
insu
lin in
fusi
on, o
r fre
quen
t nee
d fo
r poi
nt-
of-c
are
gluc
ose
mon
itorin
g (>
6 tim
es/2
4 hr
pe
riod)
as
dete
rmin
ed b
y tr
eatin
g ph
ysic
ian
•
G6P
D d
efici
ency
•
Kidn
ey s
tone
his
tory
•
Preg
nanc
y•
Enro
lled
in a
noth
er C
OVI
D-1
9 tr
ial t
hat d
oes
not a
llow
con
com
itant
stu
dy d
rugs
Seco
ndar
y •
Vent
ilato
r-fr
ee d
ays
•
ICU
-fre
e da
ys•
Hos
pita
l-fre
e da
ys•
All-
caus
e m
orta
lity
•
Chan
ge in
SpO
2/Fi
O2
ratio
dur
ing
HD
VIC
infu
sion
•
Chan
ge in
CRP
, LD
H,
D-d
imer
, lym
phoc
yte
coun
t, N
LR, s
erum
ferr
itin
from
bas
elin
e to
d 7
NC
T043
6321
675
Phar
mac
olog
ic a
scor
bic
acid
as
an a
ctiv
ator
of
lym
phoc
yte
sign
alin
g fo
r CO
VID
-19
trea
tmen
t
Uni
ted
Stat
essi
ngle
-cen
ter,
pros
pect
ive,
ra
ndom
ized
, op
en-la
bel,
phas
e II
clin
ical
tria
l
Asc
orbi
c ac
id s
olut
ion
(Asc
or®,
McG
uff
Phar
mac
eutic
als,
Lt
d.) 1
g/L
ste
rile
wat
er (+
1 g
/L
mag
nesi
um c
hlor
ide
to re
duce
bur
ning
se
nsat
ion)
IV o
ver 2
hr
s at
dos
es b
elow
q
24 h
rs (+
4) x
5 d
ays
(n=
66)
Incl
usio
n•
Mal
e or
non
-pre
gnan
t fem
ale
•
> 18
yo
•
Confi
rmed
SA
RS-C
oV-2
infe
ctio
n•
Dis
ease
sev
erity
nec
essi
tatin
g ho
spita
lizat
ion
•
Curr
ently
taki
ng s
uppl
emen
tal O
2•
No
antic
ipat
ed n
eed
(with
in 2
4 hr
s)
for m
echa
nica
l ven
tilat
ion,
defi
ned
as: (
1) p
ositi
ve c
linic
al re
spon
se to
O2
supp
lem
enta
tion
w/ i
mpr
ovem
ent i
n hy
poxi
a or
(2) h
ypox
ia im
prov
emen
t with
br
onch
ospa
sm th
erap
y if
bron
chos
pasm
pr
esen
t
Not
yet
re
crui
ting;
May
20
21
Prim
ary
•
Clin
ical
impr
ovem
ent
(Con
tinue
d)
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 17 of 29ISSN: 1740-4398
REVIEW – Vitamins and/or supplements for coronavirus drugsincontext.com
Tabl
e 2.
(Con
tinue
d)
Tria
l ID
and
titl
eLo
cati
onSt
udy
desi
gnTr
eatm
ent a
rms
(n)
Requ
irem
ents
for t
reat
men
t (in
clus
ion/
excl
usio
n)St
atus
;st
udy
end
date
Plan
ned
endp
oint
s(p
rim
ary/
seco
ndar
y)
D 0
(enr
ollm
ent d
ay)-
0.3
g/
kg; D
1- 0
.6 g
/kg;
D 2
- 0.9
g/k
g;
D 3
- 0.9
g/k
g; D
4- 0
.9 g
/kg;
D
5- 0
.9 g
/kg
SC (n
=22)
Excl
usio
n•
eGFR
< 5
0 •
G6P
D d
efici
ency
•
Ant
icip
ated
nee
d fo
r m
echa
nica
l ven
tilat
ion
with
in 2
4 hr
s•
Preg
nant
or b
reas
tfee
ding
•
Requ
ires
hom
e O
2 fo
r any
re
ason
Seco
ndar
y •
Patie
nt c
are
esca
late
d to
IC
U•
O2
supp
lem
enta
tion
•
Day
s w
ith fe
ver
•
Day
s to
dis
char
ge•
Serio
us A
E re
late
d to
tr
eatm
ent
ChiC
TR20
0003
2400
76
The
effica
cy a
nd s
afet
y of
hig
h do
se in
trav
enou
s vi
tam
in C
in th
e tr
eatm
ent
of n
ovel
cor
onav
irus
pneu
mon
ia (C
OVI
D-1
9): A
pr
ospe
ctiv
e, ra
ndom
ize,
co
ntro
lled
tria
l
Chin
aPr
ospe
ctiv
e,
rand
omiz
ed,
cont
rolle
d,
coho
rt
Hig
h do
se IV
Vita
min
C 1
00
mg/
kg/d
(n=
60)
Incl
usio
n•
Feve
r, re
spira
tory
trac
t and
ot
her s
ympt
oms
•
Imag
ing
cons
iste
nt w
ith
pneu
mon
ia
Recr
uitin
g;
6/1/
20Pr
imar
y •
CRP,
ESR
•
SIRS
Plac
ebo
norm
al s
alin
e (n
=60
)Ex
clus
ion
•
< 18
yo
•
Trea
tmen
t for
tum
or•
Preg
nant
or l
acta
ting
•
Know
n ki
dney
sto
ne(s
)•
Vita
min
C a
llerg
y•
Oth
er c
linic
al tr
ial
invo
lvem
ent
Seco
ndar
y •
CD4+
lym
phoc
yte
coun
t, ly
mph
ocyt
e co
unt,
PaO
2/Fi
O2
indi
cato
r, to
tal
bilir
ubin
, cTN
I, A
PPT,
D
-dim
er, L
DH
, CK,
ratio
of
turn
ing
to s
ever
e vi
rus,
an
d cr
ysta
lluria
Vita
min
D
NC
T043
3400
579
Effec
t of v
itam
in D
ad
min
istr
atio
n on
pr
even
tion
and
trea
tmen
t of
mild
form
s of
su
spec
ted
COVI
D-1
9
Spai
nRa
ndom
ized
, pa
ralle
l as
sign
men
t, do
uble
-blin
d
Vita
min
D 2
5,00
0 IU
PO
dai
ly
(in A
M w
/ toa
st +
oliv
e oi
l to
faci
litat
e ab
sorp
tion)
+ N
SAID
s,
ACE2
inhi
bito
r, A
RB, o
r TZD
s ba
sed
on in
vest
igat
or (n
=100
)
Incl
usio
n•
40–7
0 yo
•
Non
-sev
ere
sym
ptom
atic
pa
tient
s pr
esen
ting
with
cou
gh, f
ever
, nas
al
cong
estio
n, G
I sym
ptom
s,
fatig
ue, a
nosm
ia, a
geus
ia,
or a
ltern
ativ
e si
gns
of
resp
irato
ry in
fect
ions
Not
yet
re
crui
ting;
6/
30/2
0
Prim
ary
•
Com
posi
te o
f cum
ulat
ive
deat
h fo
r all
caus
es a
nd
spec
ific
caus
es
(Con
tinue
d)
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 18 of 29ISSN: 1740-4398
REVIEW – Vitamins and/or supplements for coronavirus drugsincontext.com
Tabl
e 2.
(Con
tinue
d)
Tria
l ID
and
titl
eLo
cati
onSt
udy
desi
gnTr
eatm
ent a
rms
(n)
Requ
irem
ents
for t
reat
men
t (in
clus
ion/
excl
usio
n)St
atus
;st
udy
end
date
Plan
ned
endp
oint
s(p
rim
ary/
seco
ndar
y)
Usu
al c
are
(NSA
IDs,
AC
E2 in
hibi
tor,
ARB
, or T
ZDs
base
d on
inve
stig
ator
) (n
=100
)
Excl
usio
n•
Seve
re re
spira
tory
and
/or m
ultis
yste
mic
sy
mpt
oms
sugg
estin
g ad
vanc
ed C
OVI
D-1
9 an
d in
terc
urre
nt a
cute
or s
ever
e ch
roni
c di
seas
es (c
ance
rs)
Seco
ndar
y •
Nee
d fo
r (no
n)in
vasi
ve
vent
ilatio
n•
ICU
or P
ACU
or h
ospi
tal
adm
issi
on
•
Med
ical
con
sulta
tion
•
Hom
e ca
re a
nd is
olat
ion
time
•
Bedr
est t
ime
•
Dur
atio
n of
sym
ptom
s an
d re
cove
ry
NC
T043
4404
180
COVI
D-1
9 an
d vi
tam
in
D s
uppl
emen
tatio
n: a
m
ultic
ente
r ran
dom
ized
co
ntro
lled
tria
l of h
igh
dose
ver
sus
stan
dard
do
se v
itam
in D
3 in
hig
h-ris
k CO
VID
-19
patie
nts
(CoV
itTria
l)
Fran
ceM
ultic
ente
r, ra
ndom
ized
, pa
ralle
l as
sign
men
t
Hig
h do
se v
itam
in D
40
0,00
0 IU
PO
dai
ly
(n=1
30)
Incl
usio
n•
≥ 70
yo
•
Dia
gnos
is o
f CO
VID
-19
by R
T-PC
R SA
RS-C
oV-2
or C
T sc
an s
ugge
stin
g vi
ral
pneu
mon
ia
•
Dia
gnos
ed w
ithin
the
prec
edin
g 3
d•
At le
ast 2
risk
fact
ors
for c
ompl
icat
ions
: (1)
≥
75 y
o, (2
) SpO
2 ≤
94%
on
room
air
or a
Pa
O2
to F
iO2
ratio
≤ 3
00 m
mH
g•
Soci
al s
ecur
ity re
cipi
ent
Recr
uitin
g; Ju
ly
2020
Prim
ary
•
Num
ber o
f dea
ths
from
an
y ca
use
durin
g th
e 14
d
follo
win
g th
e in
clus
ion
and
inte
rven
tion
Stan
dard
dos
e vi
tam
in D
50,
000
IU
PO d
aily
(n=1
30)
Excl
usio
n•
Org
an fa
ilure
requ
iring
adm
issi
on to
a
resu
scita
tion
or h
igh
depe
nden
cy u
nit
•
Life
-thr
eate
ning
com
orbi
dity
with
sho
rt-
term
life
exp
ecta
ncy
(<3
mos
life
)•
Any
reas
on th
at m
akes
follo
w-u
p at
D 2
8 im
poss
ible
•
Vita
min
D s
uppl
emen
tatio
n in
the
prev
ious
m
o (e
xcep
tion
of <
800
IU o
f vita
min
D/d
)•
Cont
rain
dica
tion
for v
itam
in D
su
pple
men
tatio
n•
Part
icip
atio
n in
ano
ther
sim
ulta
neou
s tria
l•
Pers
ons
depr
ived
of l
iber
ty, u
nder
ps
ychi
atric
car
e un
der d
ures
s, s
ubje
ct to
le
gal p
rote
ctio
n•
SpO
2 ≤
92%
in s
pite
of a
n O
2 th
erap
y >
5 L/
min
Seco
ndar
y •
Ove
rall
and
by 2
5-O
HD
le
vel a
t defi
ned
time
poin
ts•
Mor
talit
y•
Chan
ge in
WH
O O
SCI f
or
COVI
D-1
9 Se
vere
AE
•
14-d
mor
talit
y,
com
pare
d to
Fre
nch
hosp
ital g
eria
tric
uni
ts
(Con
tinue
d)
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 19 of 29ISSN: 1740-4398
REVIEW – Vitamins and/or supplements for coronavirus drugsincontext.com
Tabl
e 2.
(Con
tinue
d)
Tria
l ID
and
titl
eLo
cati
onSt
udy
desi
gnTr
eatm
ent a
rms
(n)
Requ
irem
ents
for t
reat
men
t (in
clus
ion/
excl
usio
n)St
atus
;st
udy
end
date
Plan
ned
endp
oint
s(p
rim
ary/
seco
ndar
y)
NC
T043
6384
081
The
LEA
D C
OVI
D-1
9 tr
ial:
low
-ris
k, e
arly
as
pirin
and
vita
min
D
to re
duce
CO
VID
-19
hosp
italiz
atio
ns
Uni
ted
Stat
esPh
ase
II,
mul
ticen
ter,
pros
pect
ive,
ra
ndom
ized
, co
ntro
lled
Asp
irin
81 m
g PO
da
ily x
14
d (n
=360
)In
clus
ion
•
> 18
yo
•
COVI
D-1
9 di
agno
sis
in th
e pa
st 2
4 h
Not
yet
re
crui
ting;
12
/202
0
Prim
ary
•
Hos
pita
lizat
ion
Asp
irin
81 m
g PO
da
ily +
vita
min
D
50,0
00 IU
PO
dai
ly x
14
d (n
=360
)
Excl
usio
n•
Preg
nant
pat
ient
s•
Pris
oner
s•
His
tory
of G
I ble
ed, P
UD
, spo
ntan
eous
bl
eeds
, thr
ombo
cyto
peni
a, C
KD•
Conc
urre
nt N
SAID
or s
tero
id u
se•
Hyp
ervi
tam
inos
is D
and
ass
ocia
ted
risk
fact
ors
(rena
l fai
lure
, liv
er fa
ilure
, hy
perp
arat
hyro
idis
m, s
arco
idos
is,
hist
opla
smos
is)
Seco
ndar
y •
Non
e re
port
ed
No
inte
rven
tion
(n=3
60)
NC
T043
6690
882
Prev
entio
n an
d tr
eatm
ent w
ith
calc
ifedi
ol o
f CO
VID
-19
coro
navi
rus-
indu
ced
acut
e re
spira
tory
sy
ndro
me
(SA
RS)
Spai
nRa
ndom
ized
, op
en-la
bel,
para
llel
assi
gnm
ent
Best
ava
ilabl
e th
erap
y (B
AT) +
ca
lcife
diol
266
mcg
x
2 ca
psul
es P
O
once
on
D 1
then
x 1
ca
psul
e on
D 3
, 7, 1
4,
21, a
nd 2
8 (n
=504
)
Incl
usio
n•
18–9
0 yo
•
PCR
confi
rmed
dia
gnos
is o
f CO
VID
-19
•
Radi
olog
ical
imag
e w
ith in
flam
mat
ory
pleu
ropu
lmon
ary
exud
ate
Not
yet
re
crui
ting;
8/
28/2
0
Prim
ary
•
Adm
issi
on to
ICU
•
Dea
th
BAT
com
bina
tion
ther
apy
as d
efine
d by
the
Min
istr
y of
Hea
lth a
nd/o
r co
mpl
emen
tary
no
tes
issu
ed b
y th
e Sp
anis
h A
genc
y of
Med
icin
es a
nd
Hea
lth P
rodu
cts
(n=5
04)
Excl
usio
n•
Trea
tmen
t with
cal
cife
diol
or c
hole
calc
ifero
l•
Into
lera
nce
or a
llerg
y to
cal
cife
diol
or i
ts
com
pone
nts
•
Preg
nanc
y
Seco
ndar
y •
Tim
e to
dis
char
ge•
ICU
: tim
e to
adm
issi
on,
time
mec
hani
cal
vent
ilatio
n is
rem
oved
•
Labo
rato
ry in
flam
mat
ory
mar
kers
•
Vita
min
D m
etab
olite
s•
SpO
2 an
d Sa
tO2/
FiO
2•
Dys
pnea
•
Radi
olog
ic fi
ndin
gs•
AEs
•
Hem
orrh
agic
or
thro
mbo
tic p
heno
men
a
(Con
tinue
d)
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 20 of 29ISSN: 1740-4398
REVIEW – Vitamins and/or supplements for coronavirus drugsincontext.com
Tabl
e 2.
(Con
tinue
d)
Tria
l ID
and
titl
eLo
cati
onSt
udy
desi
gnTr
eatm
ent a
rms
(n)
Requ
irem
ents
for t
reat
men
t (in
clus
ion/
excl
usio
n)St
atus
;st
udy
end
date
Plan
ned
endp
oint
s(p
rim
ary/
seco
ndar
y)
Mul
tipl
e ag
ents
stud
ied
NC
T043
3451
277
A s
tudy
of q
uint
uple
th
erap
y to
trea
t CO
VID
-19
infe
ctio
n (H
AZD
paC)
Uni
ted
Stat
esPh
ase
II,
rand
omiz
ed,
doub
le-b
lind,
pl
aceb
o-co
ntro
lled
Hyd
roxy
chlo
roqu
ine,
A
zith
rom
ycin
, Vi
tam
in C
, Vita
min
D,
+ Zi
nc x
10
d (n
=300
)
Incl
usio
n•
18–5
5 yo
•
> 2
high
ly e
ffect
ive
birt
h co
ntro
l m
etho
d•
Dia
gnos
is o
f CO
VID
-19
by R
T-PC
R
Not
yet
re
crui
ting;
4/
2021
Prim
ary
•
Succ
essf
ul tr
eatm
ent:
nega
tive
test
and
re
solu
tion
of s
ympt
oms
•
Safe
tyTo
lera
bilit
y
Mat
chin
g pl
aceb
o (n
=300
)Ex
clus
ion
•
Scre
enin
g te
st n
egat
ive
for C
OVI
D-1
9 by
RT
-PCR
•
Dia
rrhe
a (p
rior t
o in
fect
ion)
•
Any
com
orbi
ditie
s th
e in
vest
igat
or
cons
titut
es a
hea
lth ri
sk fo
r the
sub
ject
Seco
ndar
y•
Non
e re
port
ed
NC
T043
4272
878
Coro
navi
rus
dise
ase
2019
- us
ing
asco
rbic
aci
d an
d zi
nc s
uppl
emen
tatio
n (C
OVI
DAt
oZ)
Uni
ted
Stat
esRa
ndom
ized
, si
ngle
-cen
ter,
pros
pect
ive,
op
en la
bel
four
arm
Vita
min
C 8
000
mg
PO d
ivid
ed in
to 2
–3
dose
s/d
w/ f
ood
(n=1
30)
Incl
usio
n•
>18
yo•
Out
patie
nt•
Posi
tive
test
for C
OVI
D-1
9•
Non
-pre
gnan
t
Enro
lling
by
invi
tatio
n;
4/30
/21
Prim
ary
•
Sym
ptom
redu
ctio
n
Zinc
glu
cona
te 5
0 m
g PO
at b
edtim
e (n
=130
)
Vita
min
C +
Zin
c gl
ucon
ate
(dos
ing
as
abov
e) (n
=130
)
Excl
usio
n•
Posi
tive
for C
OVI
D-1
9 in
hos
pita
l or E
R•
Patie
nts
livin
g ou
tsid
e of
Ohi
o•
Preg
nant
or l
acta
ting
•
End-
stag
e CK
D•
Adv
ance
d liv
er d
isea
se a
wai
ting
tran
spla
ntat
ion
•
His
tory
of k
idne
y st
ones
Seco
ndar
y •
Reso
lutio
n of
feve
r, co
ugh,
sho
rtne
ss o
f br
eath
, and
fatig
ue•
Sym
ptom
s at
D 5
•
Hos
pita
lizat
ions
•
Seve
rity
of s
ympt
oms
•
Adj
unct
ive
med
icat
ions
•
AEs
SC (n
=130
)
NC
T043
5149
083
Impa
ct o
f zin
c an
d vi
tam
in
D3
supp
lem
enta
tion
on th
e su
rviv
al o
f ins
titut
iona
lized
ag
ed p
atie
nts
infe
cted
with
CO
VID
-19
Fran
ceRa
ndom
ized
, pa
ralle
l as
sign
men
t, op
en la
bel
Zinc
glu
cona
te
caps
ule
15 m
g x
2/d
+ 25
-OH
cho
leca
lcife
rol
drin
kabl
e so
lutio
n 10
dr
ops (
2000
IU) /
d x
2 m
os (n
=157
0)
Incl
usio
n•
> 60
yo
•
Hos
pita
lized
Not
yet
re
crui
ting;
July
20
20
Prim
ary
•
Surv
ival
rate
in
asym
ptom
atic
sub
ject
s
(Con
tinue
d)
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 21 of 29ISSN: 1740-4398
REVIEW – Vitamins and/or supplements for coronavirus drugsincontext.com
Tabl
e 2.
(Con
tinue
d)
Tria
l ID
and
titl
eLo
cati
onSt
udy
desi
gnTr
eatm
ent a
rms
(n)
Requ
irem
ents
for t
reat
men
t (in
clus
ion/
excl
usio
n)St
atus
;st
udy
end
date
Plan
ned
endp
oint
s(p
rim
ary/
seco
ndar
y)
SC (n
=157
0)Ex
clus
ion
•
Life
exp
ecta
ncy
< 1
mo
inde
pend
ent o
f CO
VID
-19
infe
ctio
n•
Hyp
erca
lcem
ia•
Rena
l lith
iasi
s
Seco
ndar
y •
Surv
ival
rate
•
COVI
D-1
9 in
cide
nce
in
asym
ptom
atic
sub
ject
s at
incl
usio
n
NC
T043
7028
862
The
clin
ical
tria
l of
appl
icat
ion
of m
ethy
lene
bl
ue v
ial f
or tr
eatm
ent o
f CO
VID
-19
patie
nts
Iran
Phas
e I,
rand
omiz
ed,
para
llel
assi
gnm
ent,
sing
le c
ente
r
MCN
(Met
hyle
ne b
lue,
vi
tam
in C
, N-a
cety
l cy
stei
ne) (
n=10
)
Incl
usio
n •
18–9
0 yo
•
Confi
rmed
cas
e of
CO
VID
-19
(by
RT-P
CR,
HRC
T)•
Adm
issi
on to
ICU
•
Nee
d fo
r int
ubat
ion
and
mec
hani
cal
vent
ilatio
n (P
aO2/
FiO
2 <
100–
200)
Recr
uitin
g;
9/20
/20
Prim
ary
•
Free
from
mec
hani
cal
vent
ilatio
n in
bot
h gr
oups
SC (n
=10)
Excl
usio
n•
Preg
nanc
y an
d br
east
feed
ing
•
G6P
D d
efici
ency
•
Prea
dmis
sion
ant
icoa
gula
tion
•
Rena
l or h
epat
ic d
isea
se•
Alle
rgy
to m
ethy
lene
blu
e•
Imm
unos
uppr
essi
ve a
gent
s•
Use
of o
ther
inve
stig
atio
nal d
rugs
at
incl
usio
n
Seco
ndar
y •
Mor
talit
y•
Impr
ovem
ent i
n Pa
02/
Fi02
ratio
•
LOS
hosp
ital
•
LOS
ICU
•
Dia
lysi
s-fr
ee d
ays
•
CRP
•
WBC
IRC
T202
0031
9046
819N
169
Impa
ct o
f vita
min
B, A
, D,
E, a
nd C
sup
plem
enta
tion
on im
prov
emen
t and
m
orta
lity
rate
in p
atie
nts
with
CO
VID
-19
adm
itted
in
inte
nsiv
e ca
re u
nit
Iran
Rand
omiz
ed,
sing
le-
blin
ded,
pa
ralle
l
Vita
min
A 2
5,00
0 IU
PO
dai
ly +
vita
min
D
600,
000
IU P
O x
1 +
vi
tam
in E
300
IU P
O
BID
+ v
itam
in C
500
m
g PO
QID
+ v
itam
in
B (S
oluv
it) 1
am
pule
da
ily x
1 w
k (n
=30)
Incl
usio
n:•
20–6
0 yo
•
COVI
D-1
9 cl
inic
al o
r defi
nitiv
e di
agno
sis
•
BMI 1
8.5–
30•
No
liver
or k
idne
y di
sord
ers
Recr
uitin
g; n
ot
prov
ided
Prim
ary
•
Infla
mm
ator
y m
aker
s•
Pulm
onar
y in
volv
emen
t (C
T)•
Mor
talit
y
SC (n
=30)
Excl
usio
n:•
Rare
vira
l dis
ease
s•
Chem
othe
rapy
in p
rior m
o•
Any
oth
er s
peci
fic c
ondi
tion
Seco
ndar
y•
BMI
•
LOS
•
SpO
2
(Con
tinue
d)
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 22 of 29ISSN: 1740-4398
REVIEW – Vitamins and/or supplements for coronavirus drugsincontext.com
Tabl
e 2.
(Con
tinue
d)
Tria
l ID
and
titl
eLo
cati
onSt
udy
desi
gnTr
eatm
ent a
rms
(n)
Requ
irem
ents
for t
reat
men
t (in
clus
ion/
excl
usio
n)St
atus
;st
udy
end
date
Plan
ned
endp
oint
s(p
rim
ary/
seco
ndar
y)
IRC
T202
0032
4046
850N
163
Com
paris
on o
f vita
min
D
3 an
d N
-ace
tylc
yste
ine
pres
crip
tion
in C
OVI
D-1
9 pa
tient
s an
d th
eir e
ffect
on
reco
very
pro
cess
Iran
Rand
omiz
ed,
sing
le-
blin
ded,
fa
ctor
ial t
rial
SC w
/ nat
iona
l dru
gs
(n=2
5)In
clus
ion
•
COVI
D-1
9 po
sitiv
e ba
sed
on c
hest
CT
with
sev
ere
sym
ptom
s (fe
ver,
mus
cle
pain
, SO
B, d
ry c
ough
, sor
e th
roat
, run
ny
nose
)•
Confi
rmat
ion
of C
OVI
D-1
9 by
an
infe
ctio
us d
isea
se p
hysi
cian
Recr
uitin
g;
5/21
/20
Prim
ary
•
SOB,
cou
gh, c
hills
, nig
ht
swea
tsSC
w/ n
atio
nal d
rugs
+
vita
min
D3
50,0
00
IU o
nce
a w
k (n
=25)
SC w
/ nat
iona
l dru
gs
+ n-
acet
ylcy
stei
ne
(NAC
) 600
mg
PO
daily
(n=2
5)
Excl
usio
n•
Taki
ng m
edic
atio
ns o
ther
than
the
ones
m
entio
ned
in th
is s
tudy
•
Preg
nant
and
lact
atin
g w
omen
•
Taki
ng lo
sart
an o
r cap
topr
il•
His
tory
of i
ntes
tinal
ulc
ers
or G
I ble
ed
Seco
ndar
y •
Non
e re
port
ed
SC w
/ nat
iona
l dru
gs
+ vi
tam
in D
3 50
,000
IU
+ N
AC 6
00 m
g PO
on
ce a
wk
(n=2
5)
25-O
HD
, cal
cife
diol
; ACE
2, A
ngio
tens
in-c
onve
rtin
g en
zym
e 2;
AE,
adv
erse
eve
nt; A
M, m
orni
ng; A
PACH
E, A
cute
Phy
siol
ogic
Ass
essm
ent a
nd C
hron
ic H
ealth
Eva
luat
ion;
APP
T,
activ
ated
par
tial t
hrom
bopl
astin
tim
e; A
RB, A
ngio
tens
in II
rece
ptor
blo
cker
s; BI
D, t
wic
e da
ily; B
MI,
body
mas
s in
dex;
CD
I: Cl
ostr
idiu
m d
iffici
le in
fect
ion;
CK,
cre
atin
e ki
nase
; CK
D, c
hron
ic k
idne
y di
seas
e; c
m, c
entim
eter
; CO
PD, c
hron
ic o
bstr
uctiv
e pu
lmon
ary
diso
rder
; CPR
, car
diop
ulm
onar
y re
susc
itatio
n; C
RP, c
-rea
ctiv
e pr
otei
n; C
T, c
ompu
teriz
ed
tom
ogra
phy;
cTN
I, ca
rdia
c tr
opon
in I;
d, d
ay; D
HA
, doc
osah
exae
noic
aci
d; E
PA, e
icos
apen
taen
oic
acid
; ER,
em
erge
ncy
room
; ESR
, ery
thro
cyte
sed
imen
tatio
n ra
te; g
, gra
m;
G6P
D, g
luco
se-6
-pho
spha
te d
ehyd
roge
nase
; GI,
gast
roin
test
inal
; GLA
, gam
ma-
linol
enic
aci
d; H
DVI
C, h
igh
dose
IV v
itam
in C
; HIV
, Hum
an Im
mun
odefi
cien
cy V
irus;
HC
V,
Hep
atiti
s C
Viru
s; hr
(s),
hour
(s);
IBD
, infl
amm
ator
y bo
wel
dis
ease
; ICU
, int
ensi
ve c
are
unit;
IL-6
, int
erle
ukin
-6; I
U, i
nter
natio
nal u
nit;
IV, i
ntra
veno
us; k
g, k
ilogr
am; L
, lite
r; LD
H,
lact
ate
dehy
drog
enas
e; L
OS,
leng
th o
f sta
y; L
PV/r
, lop
inav
ir/rit
onav
ir; m
cg, m
icro
gram
; mg,
mill
igra
m; m
L, m
illili
ter;
mm
Hg,
mill
imet
er o
f mer
cury
; mo(
s), m
onth
(s);
MS,
mul
tiple
sc
lero
sis;
n= n
umbe
r; N
EWS,
nat
iona
l ear
ly w
arni
ng s
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Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 23 of 29ISSN: 1740-4398
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leading to imposing limitations on the quantity that can be purchased.84
Although the use of remdesivir has been expanded in the United States, its role in the fight of COVID-19 has not provided patients and providers with the relief they expected. Although no difference in clinical outcomes was observed between 5 and 10 days of remdesivir treatment, a study conducted in Hubei, China, failed to demonstrate clinical improvements in adults with severe COVID-19 in the remdesivir arm.85,86 Interestingly, time to clinical improvement in patients treated earlier was observed but needs confirmation in larger studies.85 In an exploratory analysis, the sponsor of remdesivir, Gilead Sciences, Inc., found that patients who received remdesivir within 10 days of symptoms onset had improved outcomes compared with those treated after more than 10 days of symptoms. Additionally, when data were pooled across treatment arms, by Day 14, 62% of patients treated early were discharged from the hospital compared to those who were treated late; yet statistical analysis was not performed.86 Furthermore, notable exclusion criteria in these moderate-to-severe COVID-19 patients included mechanical ventilation at screening as well as patients receiving mechanical ventilation > 5 days or extracorporeal membrane oxygenation, alanine aminotransferase or aspartate aminotransferase > 5 X upper limit of normal (ULN), and creatinine clearance (CrCL) < 50 mL/min.14,15 Therefore, the true potential and efficacy of remdesivir therapy require expanded investigation into additional populations.
Although doses of vitamins in these ongoing clinical trials are higher than normal, use of vitamins at higher doses compared to recommended dietary allowance is safe, and upper limits for the use are defined. In addition, the use of vitamins and herbal supplements likely has more benign side effects when compared to self-medicating with unproven remedies lacking adequate investigations for use. In the instance of chloroquine phosphate and its derivative hydroxychloroquine, a wife and husband ingested chloroquine phosphate in the United States in March 2020, after hearing from a press conference that this medication was likely a very promising treatment option. The couple consumed hydroxychloroquine based on the intended use for their aquarium because they feared contracting the virus, and it was easily accessible. They were both hospitalized shorty after ingesting the product, and the husband ultimately died.87 Meanwhile, hundreds in Iran died after drinking neat alcohol in early 2020, which was publicized on social media as a cure/prevention for COVID.88 It is not clear how many of these deaths can be directly tied to social media misinformation, as a larger problem of contaminated bootleg alcohol was revealed.
The most studied supplement in the acute care setting has been vitamin C, where it has been used as treatment for multiple conditions, including sepsis, acute bronchitis, cardiovascular disease, postoperative infection, and prevention of contrast-induced nephropathy. A meta-analysis published in
2019, reviewed 18 trials to evaluate the effect of vitamin C on intensive care unit (ICU) length of stay and duration of mechanical ventilation. The most commonly studied populations were patients undergoing cardiac surgery, followed by sepsis, lung contusions, and burn patients. Of 12 trials containing 1766 patients, intravenously administered vitamin C reduced the length of ICU stay by 7.8% (95% confidence interval [CI]: 4.2–11.2; p=0.00003). Orally administered vitamin C in doses of 1–3 g/day was evaluated in 6 studies and was associated with reduced length of ICU stay by 8.6% (p=0.003). Of the 3 studies evaluating patients requiring mechanical ventilation for >24 h, vitamin C reduced the duration of mechanical ventilation by 18.2% (95% CI: 7.7–27; p=0.001).89
These authors also performed a meta-regression analysis in critically ill patients receiving mechanical ventilation and found that in 5 studies consisting of 471 patients, vitamin C (1–6 g/day) was most beneficial in reducing ventilation time by an average of 25% (p<0.0001) in patients requiring more than 10 h of mechanical ventilation.90 These findings can serve as a foundation for analyzing the role of vitamin C in potentially reducing the time spent on mechanical ventilation in patients with COVID-19.
Vitamin C Infusion for Treatment in Sepsis Induced Acute Lung Injury (CITRIS-ALI), a randomized, double-blind, placebo-controlled, multicenter trial conducted in 7 medical ICUs in the USA evaluated the effects of vitamin C infusion in 167 patients and its role in organ failure along with biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure. Patients were assigned to receive either an infusion of vitamin C, 50 mg/kg, or placebo dextrose, 5% in water, every 6 h for 96 h. Although this study failed to improve organ dysfunction scores or alter markers of inflammation and vascular injury, vitamin C was associated with a significant reduction in 28-day all-cause mortality as well as significantly increased ICU-free days to day 28 and hospital-free days to day 60.91 These findings also suggest that further research may be warranted to determine whether vitamin C has a role in the care of patients with sepsis and acute respiratory distress syndrome (ARDS), which has been associated with COVID-19.
Vitamin D is currently under evaluation for its role in COVID-19 for its immunomodulatory effects. A trial conducted in Guinea-Bissau investigated vitamin D as supplementary treatment for tuberculosis in 365 patients. The intervention was 100,000 IU of cholecalciferol or placebo at inclusion and again at 5 and 8 months after the initiation of treatment. Findings from this study failed to demonstrate improvements in clinical outcomes or mortality in patients receiving vitamin D as part of tuberculosis treatment, but this may be due to the dose not being high enough or given consistently.
Additional studies evaluating the role of vitamin D supplementation in the prevention and reduction of acute respiratory infections, COPD exacerbations, and pneumonia were analyzed in the Vitamin D3 Supplementation in Patients
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 24 of 29ISSN: 1740-4398
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excluded in many of these ongoing trials as well. This includes women, who are pregnant or lactating, as well as patients with chronic diseases (i.e. kidney disease), or patients with short life expectancies (i.e. cancers).
The greatest promise in combatting this life-threatening virus appears to be through reducing the cytokine storm associated with COVID-19.95 This is where anti-inflammatory and antioxidant vitamins and supplements may play a potential role. Results of these ongoing clinical trials are urgently needed.
At this time, we recommend vitamins and supplements as specific COVID-19 treatment in the context of a clinical trial. This recommendation is in-line with the major organizational guidelines for potentially effective COVID-19 treatments at the time of this writing. While the vitamins and supplements under investigation for COVID-19 described in this manuscript are generally without serious adverse effects and drug interactions, no therapy is completely free of risk. Additionally, while also being generally affordable, broad recommendation and implementation of unproven treatments are likely not cost effective. That being said, vitamins and supplements with existing evidence supporting their use in conditions associated with COVID-19, such as sepsis or ARDS, can be considered when potential benefit is determined to outweigh risk.
ConclusionWith the rapidity of hypothetical treatments’ data being generated for COVID-19, clinical investigations up until this point have not provided efficacious treatments in eradicating the virus. While it is important to investigate treatments with the potential to reduce the severity and consequences of COVID-19, vitamins and supplements should be continued to be evaluated to provide the much-needed evidence for possible treatment modalities. A systematic review will be conducted once results from ongoing and recruiting clinical trials are available.
with Chronic Obstructive Pulmonary Disease (ViDiCO) trial. This trial investigated whether vitamin D3 supplementation would reduce the incidence of moderate or severe COPD exacerbations and upper respiratory infections in 240 patients across clinics in London. Patients received six 2-month oral doses of 3 mg of vitamin D over a 1-year period. Vitamin D3 was associated with protective effects against moderate or severe COPD exacerbations in participants with baseline serum 25-hydroxyvitamin D concentrations of less <50 nmol/L (p=0·021), but not in those with baseline concentrations > 50 nmol/L. Baseline serum 25-hydroxyvitamin D concentrations had no effect on time to first upper respiratory infection.92
A systematic review and meta-analysis evaluated 24 randomized, controlled trials of supplementation with vitamin D in regard to incidence of acute respiratory tract infection. Protective effects were observed in subjects receiving daily or weekly vitamin D supplementation without additional bolus doses and were stronger in those with baseline 25-hydroxyvitamin D levels <25 nmol/L. Serum 25(OH)D concentration was inversely associated with risk and severity of acute respiratory tract infection; where for each 10 nmol/L decrease in 25(OH)D concentration, the odds of acute respiratory tract infection increased by 1.02 (0.97–1.07).93 Therefore, some protective effects of vitamin D in those with lower baseline levels have been seen. However, the role of vitamin D for the treatment of acquired infections, including COVID-19, requires further investigation especially in subjects with low baseline levels of vitamin D. This concept is currently under investigation in France.94
When evaluating proposed studies of vitamins and supplements throughout the world, there are notable limitations in currently available information, such as standard of care. While many of the studies report a comparator arm as standard of care, there is no definition of what that actually means as there is no widely recognized treatment for COVID-19. In addition, much like other clinical trials, key populations are
Contributions: Drs Michienzi and Badowski both developed the concept for this manuscript and equally contributed to the research, analysis, and writing of the manuscript and development of tables and figures. Both named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.
Disclosure and potential conflicts of interest: The authors declare that they have no conflicts of interest. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2020/05/dic.2020-5-7-COI.pdf
Acknowledgements: The authors thank Dr Edwin Le, PharmD, Dr Samona Rawal, PharmD, and Dr Tiffany Wu, PharmD, for their assistance with reviewing available literature and studies.
Funding declaration: There was no funding associated with the preparation of this article.
Copyright: Copyright © 2020 Michienzi SM, Badowski ME. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.
Correct attribution: Copyright © 2020 Michienzi SM, Badowski ME. https://doi.org/10.7573/dic.2020-5-7. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.
Michienzi SM, Badowski ME. Drugs in Context 2020; 9: 2020-5-7. DOI: 10.7573/dic.2020-5-7 25 of 29ISSN: 1740-4398
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Article URL: https://www.drugsincontext.com/can-vitamins-and-or-supplements-provide-hope-against-coronavirus?
Correspondence: Melissa E Badowski, MPH, 833 S. Wood, MC886, Room 164, Chicago, IL, 60612, USA. [email protected]
Provenance: invited; externally peer reviewed.
Submitted: 14 May 2020; Peer review comments to author: 18 May 2020; Revised manuscript received: 28 May 2020; Accepted: 29 May 2020; Publication date: 22 June 2020.
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