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Vitamin CPhase 3LOVIT-COVIDNCT04401150

Lessening Organ Dysfunction With VITamin C - COVID-19

A Phase 3 study testing Vitamin C in people with Vitamin C and COVID-19, run by Université de Sherbrooke at 2 sites in Canada.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

LOVIT-COVID is a multicentre concealed-allocation parallel-group blinded randomized controlled trial to ascertain the effect of high-dose intravenous vitamin C compared to placebo on mortality or persistent organ dysfunction at 28 days in hospitalized COVID-19 patients. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Vitamin C, COVID-19, Hospitalized Patients
What is being tested?
Vitamin C
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
392 participants
Where
2 sitesCanada
Study dates
14 Aug 2020to 6 Dec 2022
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Confirmed diagnosis of COVID-19;
  • Admitted to hospital (ward or intensive care unit).

Who cannot join

  • Receiving or has received vasopressors during the current hospitalization;
  • More than 24 hours has elapsed since receipt of non-invasive ventilatory support (high-flow nasal cannula or continuous positive airway pressure or non-invasive ventilation) or invasive mechanical ventilation;
  • Patient is expected to be discharged from the hospital in the next 24 hours;
  • More than 14 days have elapsed since the commencement of hospital admission with respiratory illness;
  • Known glucose-6-phosphate dehydrogenase (G6PD) deficiency;
  • Known sickle cell anemia
Show all 14Show fewer
  • Pregnancy or breastfeeding;
  • Known allergy to vitamin C;
  • Known kidney stones within the past 1 year;
  • Received any intravenous vitamin C during this hospitalization unless incorporated in parenteral nutrition;
  • Expected death or withdrawal of life-sustaining treatments within 48 hours;
  • Previously enrolled in this study;
  • Previously enrolled in a trial for which co-enrolment is not allowed (co- enrolment to be determined case by case).
  • The trial has broad eligibility criteria and includes all COVID-19 patients admitted to the hospital (e.g. hospital ward or the intensive care unit) who are not receiving vasopressors.

Trial locations and contacts

2 sites in 1 country.

Canada2 sites
  • Research Center of the CHUS

    Sherbrooke, Quebec, J1H 5N4

  • Research Centre of the CHUS

    Sherbrooke, Quebec, J1H 5N4

Other trials in Canada

About this study

Official title: Lessening Organ Dysfunction With VITamin C - COVID

LOVIT-COVID is a multicentre concealed-allocation parallel-group blinded randomized controlled trial to ascertain the effect of high-dose intravenous vitamin C compared to placebo on mortality or persistent organ dysfunction at 28 days in hospitalized COVID-19 patients.

Read the detailed description

Background. Research suggests that vitamin C is potentially lifesaving in the intense inflammatory cascade such as that associated with COVID-19. Inflammation and oxidative stress are among the main mechanisms underlying COVID-19-associated acute hypoxemic respiratory failure. Previous evidence had also already established that a dysregulated inflammatory cascade may distinguish patients who transition from a relatively mild viral pneumonitis to acute respiratory distress syndrome and multiorgan failure. As such, adjunct immune modulation therapies may improve outcomes of COVID-19 patients who are hospitalized. Numerous preclinical studies have shown that, in addition to direct scavenging of oxygen radicals, vitamin C limits their production and restores endothelial function.

As the majority of hospitalized patients with COVID-19 are not critically ill, avoiding clinical deterioration and subsequent intensive care unit admission is a high priority. Participation in research should be offered before patients become critically ill, at which time many perceive that treatment may be too late. It is important to ensure that as many COVID-19 patients as possible are offered the opportunity to participate to research since that is generally the only means to access investigational therapies. The proposed trial will address this gap, by evaluating the efficacy of intravenous vitamin C in hospitalized patients with confirmed COVID-19.

Objectives. The overarching objective, which is identical to the objective of the parent LOVIT trial (NCT 03680274), is to determine whether intravenous vitamin C, compared to placebo, reduces morbidity and mortality in patients hospitalized with COVID-19. To ascertain the volume of distribution, clearance, and plasma concentration over a course of 96 hours of intravenous vitamin C 50 mg/kg of weight every 6 hours or matching placebo (pharmacokinetic (PK) substudy).

Methods. Patients will be randomly assigned to vitamin C (intravenous, 50 mg/kg every 6h) or placebo (0.9% NaCl or dextrose 5% in water) for 96 hours. Study personnel at the clinical sites will document the composite of death or persistent organ dysfunction at day 28. Daily assessments will occur for organ function, on days 1, 3, 7 for inflammation, infection, and endothelial injury biomarkers, at baseline for vitamin C level, and at 6 months for mortality and HRQoL. The LOVIT-COVID Trial will be conducted in Canadian and possibly international sites. For the PK substudy: Blood samples will be drawn around the 8th dose at time 0 and then after administration at times 1h, 2h, 4h and 6h (the 6h level will be immediately prior to the next dose). The PK substudy will be conducted with 100 participants in some of the participating centers.

Relevance. A growing body of evidence suggests that vitamin C, an inexpensive and readily available intervention, is potentially lifesaving in sepsis and may also be beneficial in COVID-19. LOVIT-COVID will constitute rigorous assessments of the effect of vitamin C monotherapy on patient-important outcomes. If proven effective, vitamin C could be used worldwide and drastically change outcomes in high- and low-income settings alike.

Being tested
Vitamin C, Control
Keywords
Vitamin C, COVID-19, Hospitalized patients, Pandemic, Coronavirus
Medical subject headings
COVID-19, Coronavirus Infections

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Vitamin CDrug

    Also called Ascorbic acid

    Intravenous vitamin C administered in bolus doses of 50 mg/kg mixed in a 50-ml solution of either normal saline (0.9% NaCl) or dextrose 5% in water (D5W) during 30 to 60 minutes, every 6 hours for 96 hours (i.e. 200 mg/kg/day and 16 doses in total).

  • ControlDrug

    Also called Placebo

    Dextrose 5% in water of normal saline (0.9% NaCL) in a volume to match vitamin C.

Study groups in NCT04401150
Study groupRoleWhat they receive
Vitamin CExperimentalVitamin C: 50 mg/kg of weight administered intravenously every 6 hours for 96 hours (16 doses).
Receives: Drug: Vitamin C
ControlPlacebo comparatorNormal saline (0.9% NaCl) or dextrose 5% in water (D5W) in a volume to match the vitamin C.
Receives: Drug: Control

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Death or persistent organ dysfunction

    Number of deceased participants or with persistant organ dysfunction (dependency on mechanical ventilation, new renal replacement therapy, or vasopressors).

    Measured: Both assessed at 28 days

Secondary outcomes (15)
  1. Number of intensive care unit-free days

    Number of whole and part study days for which the patient is alive and not admitted to an intensive care unit

    Measured: Assessed at 21 days

  2. Persistent organ dysfunction-free days in ICU

    Number of study days in ICU without persistant organ dysfunction

    Measured: Assessed at 28 days

  3. Number of patients deceased at 6 months

    Mortality at 6 months

    Measured: 6 months

  4. Health related quality of life in 6-month survivors

    Assessed by the EQ-5D-5L EuroQol questionnaire (EQ-5D-5L). The EQ-5D-5L essentially consists of 2 pages: the EQ-5D descriptive system and the EQ-5D visual analog scale (EQ VAS). The descriptive system comprises 5 dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems, and extreme problems. The patient is asked to indicate her/his health state by ticking the box next to the most appropriate statement in each of the 5 dimension. This decision results in a 1-digit number that expresses the level selected for that dimension. The digits for the 5 dimensions can be combined into a 5-digit number that describes the patient's health state.

    The EQ-VAS records the patient's self-rated health on a vertical visual analog scale, where the endpoints are labelled 'The best health you can imagine' and 'The worst health you can imagine'.

    Measured: 6 months

  5. Organ function

    Assessed by the Sequential Organ Failure Assessment (SOFA) score. Used to track a person's status during the stay in an intensive care unit to determine the extent of a person's organ function or rate of failure. The score is based on six different sub-scores, one each for the respiratory (PaO2/fraction of inspired oxygen FiO2) mmHg), cardiovascular (mean arterial pressure OR administration of vasopressors required), hepatic (liver bilirubin mg/dl [µmol/L]), coagulation (platelets x 103/µl), renal (kidneys creatinine (mg/dl) [µmol/L] (or urine output)), and neurological (Glasgow coma scale). The sub-score of each system ranges from 0 (best) to +4 (worst).

    Measured: Days 1, 2, 3, 4, 7, 10, 14, 28

  6. Global tissue dysoxia

    Assessed by serum lactate concentration

    Measured: Days 1, 3, 7

  7. Rate of inflammation

    Assessed by interleukin-1 beta (IL-1ß), tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP).

    Measured: Days 1, 3, 7

  8. Rate of infection

    Assessed by procalcitonin (PCT).

    Measured: Days 1, 3, 7

  9. Rate of endothelial injury

    Assessed by thrombomodulin (TM) and angiopoietin-2 (ANG-2).

    Measured: Days 1, 3, 7

  10. Occurrence of stage 3 acute kidney injury

    Assessed by Kidney Disease: Improving Global Outcomes (KDIGO) criteria

    Measured: Up to day 28

  11. Acute hemolysis

    • clinician judgment of hemolysis, as recorded in the chart, OR
    • hemoglobin drop of at least 25 g/L within 24 hours of a dose of investigational product plus 2 of the following:
    • reticulocyte count >2 times upper limit of normal at clinical site lab;
    • haptoglobin <lower limit of normal at clinical site lab;
    • indirect (unconjugated) bilirubin >2 times upper limit of normal at clinical site lab;
    • lactate dehydrogenase (LDH) >2 times upper limit of normal at clinical site lab.

    Severe hemolysis:

    • hemoglobin <75 g/L AND at least 2 of the above criteria AND requires 2 units of packed red blood cells.

    Measured: Up to day 28

  12. Hypoglycemia

    Core lab-validated glucose level <3.8 mmol/L

    Measured: During the time participants receive the 16 doses of the investigational product and the 7 days following the last dose.

  13. Vitamin C volume of distribution

    Assessed by chromatography-tandem mass spectrometry

    Measured: 8th dose of vitamin C at time 0 (immediately prior to the dose) and then after administration at times 1 hour, 2 hours, 4 hours and 6 hours (Pharmacokynetic substudy).

  14. Vitamin C clearance

    Assessed by chromatography-tandem mass spectrometry

    Measured: 8th dose of vitamin C at time 0 (immediately prior to the dose) and then after administration at times 1 hour, 2 hours, 4 hours and 6 hours (Pharmacokynetic substudy).

  15. Vitamin C plasma concentration

    Assessed by chromatography-tandem mass spectrometry

    Measured: 8th dose of vitamin C at time 0 (immediately prior to the dose) and then after administration at times 1 hour, 2 hours, 4 hours and 6 hours (Pharmacokynetic substudy).

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 May 2020
  2. Study start14 Aug 2020
  3. Primary completion15 Jul 2022
  4. Study completion6 Dec 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Randomized controlled trial
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
392 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04401150
Sponsor's protocol ID
MP-31-2021-3741
Acronym
LOVIT-COVID
Status last verified
Apr 2023
First submitted
21 May 2020
Last updated
21 Apr 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • LOVIT-COVID Investigators, on behalf of the Canadian Critical Care Trials Group, and the REMAP-CAP Investigators; Adhikari NKJ, Hashmi M, Tirupakuzhi Vijayaraghavan BK, Haniffa R, Beane A, Webb SA, Angus DC, Gordon AC, Cook DJ, Guyatt GH, Berry LR, Lorenzi E, Mouncey PR, Au C, Pinto R, Menard J, Sprague S, Masse MH, Huang DT, Heyland DK, Nichol AD, McArthur CJ, de Man A, Al-Beidh F, Annane D, Anstey M, Arabi YM, Battista MC, Berry S, Bhimani Z, Bonten MJM, Bradbury CA, Brant EB, Brunkhorst FM, Burrell A, Buxton M, Cecconi M, Cheng AC, Cohen D, Cove ME, Day AG, Derde LPG, Detry MA, Estcourt LJ, Fagbodun EO, Fitzgerald M, Goossens H, Green C, Higgins AM, Hills TE, Horvat C, Ichihara N, Jayakumar D, Kanji S, Khoso MN, Lawler PR, Lewis RJ, Litton E, Marshall JC, McAuley DF, McGlothlin A, McGuinness SP, McQuilten ZK, McVerry BJ, Murthy S, Parke RL, Parker JC, Reyes LF, Rowan KM, Saito H, Salahuddin N, Santos MS, Saunders CT, Seymour CW, Shankar-Hari M, Tolppa T, Trapani T, Turgeon AF, Turner AM, Udy AA, van de Veerdonk FL, Zarychanski R, Lamontagne F. Intravenous Vitamin C for Patients Hospitalized With COVID-19: Two Harmonized Randomized Clinical Trials. JAMA. 2023 Nov 14;330(18):1745-1759. doi: 10.1001/jama.2023.21407.

    PubMed 37877585

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Vitamin C in people with Vitamin C and COVID-19, run by Université de Sherbrooke at 2 sites in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 21 Apr 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Death or persistent organ dysfunction (time frame: Both assessed at 28 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04401150, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Apr 2023.

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