Two known therapies could be useful as adjuvant therapy in critical patients infected by COVID-19

Hernández, A.; Papadakos, Peter J.; Torres, Antoni; Gonzalez, Debbie; Vives, Marc; Ferrando, Carlos; Baeza, J.A.

doi:10.1016/j.redare.2020.05.002

Cited by 48 publications

(73 citation statements)

References 34 publications

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“…As vitamin C has the ability to restore endothelial function, it might help to reduce the risk of development of this complication if used early in the course of management of COVID-19. Treatment with IV vitamin C, as a monotherapy, might help to reduce lung inflammation and lung injury in COVID-19 [ 93 ]. An expert group on clinical treatment of COVID-19 in Shanghai advised that high dose of IV vitamin C is recommended to prevent cytokine storm in patients with mild or general symptoms of COVID-19 [ 94 ].…”

Section: The Beneficial Effect Of Vitamin C In Management Of Covid-19mentioning

confidence: 99%

Overview of the possible role of vitamin C in management of COVID-19

2020

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The mainstay of management of coronavirus disease 2019 (COVID-19) is mainly supportive as to date there is no effective antiviral treatment, apart from remdesivir which has been approved by Food and Drug administration (FDA) for treatment of COVID-19, or vaccine. Supplementation with micronutrients, such as vitamins and minerals, has gained an increasing interest as part of the supportive management of COVID-19. Vitamin C levels in serum and leukocytes are depleted during the acute stage of infection owing to increased metabolic demands. High-dose vitamin C supplement helps to normalise both serum and leukocytes vitamin C levels. Vitamin C has multiple pharmacological characteristics, antiviral, anti-oxidant, anti-inflammatory and immunomodulatory effects, which make it a potential therapeutic option in management of COVID-19. The use of high dose of intravenous vitamin C for management of COVID-19 in China and the United Stated has shown promising results. There were no reported adverse reactions with the short-term use of high dose of vitamin C. Given the fact that vitamin C is cheap, available and safe drug with beneficial effects in management of viral infections and critically ill patients reported in previous clinical trials, it is sensible to add it to COVID-19 management protocol particularly if the current ongoing clinical trials testing the effect of vitamin C in management of COVID-19 show positive results.

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Section: The Beneficial Effect Of Vitamin C In Management Of Covid-19mentioning

confidence: 99%

Overview of the possible role of vitamin C in management of COVID-19

2020

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“…A randomized placebo-controlled study showed that vitamin C (500 mg twice daily) alleviates the inflammatory status by reducing, among others, IL-6 and C-reactive protein in hypertensive and/or diabetic obese patients [64] . This suggests that vitamin C may also be of use in severe forms of COVID-19 [65] . Vitamin C may also inhibit the ability of neutrophils to form neutrophil extracellular traps, which may contribute to organ damage and mortality in COVID-19 [66] .…”

Section: Introductionmentioning

confidence: 99%

Vitamin C as prophylaxis and adjunctive medical treatment for COVID-19?

Feyaerts

Luyten

2020

Nutrition

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Highlights Severe acute respiratory syndrome coronavirus 2 causes a respiratory infection, at times followed by severe systemic illness. Low dose (0.5–2 g/d) vitamin C may have benefits when used early in severe acute respiratory syndrome coronavirus 2 infections. Severe late forms of coronavirus disease 2019 are due to a cytokine storm involving interleukin-6 and endothelin-1. Vitamin C (especially at high doses) can reduce mediators such as interleukin-6 and endothelin-1. Thus, vitamin C may also benefit patients with severe late-stage coronavirus disease 2019.

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“…Our findings are consistent with recent reviews describing the potential biologically plausible benefits associated with ozonated autohemotherapy for COVID-19. [27][28][29] There is a potential role for ozonated autohemotherapy for treatment of patients with severe COVID-19 pneumonia, with several biological plausible mechanisms of action. When human blood is exposed to a gas mixture of oxygen and ozone, oxygen equilibrates with the extracellular and intraerythrocytic water before becoming bound to hemoglobin until it is fully oxygenated.…”

Section: Discussionmentioning

confidence: 99%

Ozone therapy for patients with COVID-19 pneumonia: a Quasi-Randomized Controlled Trial

Hernández¹,

Viñals²,

Pablos³

et al. 2020

Preprint

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Importance Aside from supportive management, there remains no specific treatment for Coronavirus Disease 2019 (COVID-19). Objective: Determine whether ozonated autohemotherapy is associated with a shorter time to clinical improvement in patients with severe COVID-19 pneumonia. Design: Single-center proof-of-concept prospective cohort study. Setting: Internal Medicine ward at Policlinica Ibiza Hospital, Spain. Participants: Eighteen consecutive patients with laboratory confirmed COVID-19 infection and severe pneumonia who were admitted to hospital between 20th March and 19th April 2020. Exposures: Patients in the ozonated autohemotherapy arm received hemotherapy twice daily starting on the day of admission for a median of 4 days. Each treatment involved administration of 200 mL autologous whole blood enriched with 200 mL of oxygen-ozone mixture with a 40 μg/mL ozone concentration. Patients in the control arm received supportive care. Assignment to hemotherapy versus usual care was determined based on the admitting physician on the day of admission, with only one of the three possible physicians prescribing ozonated autohemotherapy Main Outcomes: The primary outcome was time from hospital admission to clinical improvement, which was defined as either hospital discharge or a two-point improvement in clinical status measured on a six-point ordinal scale. Secondary outcomes were clinical improvement measured on the 7th, 14th and 28th day after admission, as well as time to a 2-fold reduction in concentrations of C-protein reactive, ferritin, D-dimer and lactate dehydrogenase. Results: The mean age of the cohort was 68 y and 72% (n=13) were male. Nine patients (50%) received ozonated autohemotherapy beginning on the day of admission. In unadjusted comparisons, ozonated autohemotherapy was associated with significantly shorter time to clinical improvement (median [IQR]), 7 days [6-10] vs 28 days [8-31], p=0.04) and significantly higher proportion of patients achieving 14-day clinical improvement (88.8% vs 33.3%, p=0.01). In risk-adjusted analyses, ozonated autohemotherapy was associated with a shorter mean time to clinical improvement (-11.3 days, p=0.04, 95% CI -22.25 to -0.42). Conclusions and Relevance: Ozonated autohemotherapy was associated with a significantly shorter time to clinical improvement in this prospective cohort study. Given the small sample size and single-center study design, these observations require evaluation in larger randomized controlled trials.

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Two known therapies could be useful as adjuvant therapy in critical patients infected by COVID-19

Cited by 48 publications

References 34 publications

Overview of the possible role of vitamin C in management of COVID-19

Overview of the possible role of vitamin C in management of COVID-19

Vitamin C as prophylaxis and adjunctive medical treatment for COVID-19?

Ozone therapy for patients with COVID-19 pneumonia: a Quasi-Randomized Controlled Trial

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