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Lessening Organ Dysfunction With VITamin C (LOVIT)

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ClinicalTrials.gov Identifier: NCT03680274
Recruitment Status : Recruiting
First Posted : September 21, 2018
Last Update Posted : December 21, 2018
Sponsor:
Collaborator:
Lotte & John Hecht Memorial Foundation
Information provided by (Responsible Party):
François Lamontagne, Université de Sherbrooke

Brief Summary:
LOVIT 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 septic intensive care unit patients.

Condition or disease Intervention/treatment Phase
Sepsis Vitamin C Intensive Care Unit Drug: Vitamin C Other: Control Phase 3

Detailed Description:

Background. The burden of sepsis is increasing worldwide. It is the cause of 8 million global deaths each year. Currently, treatment options are limited to antimicrobials and supportive care such as intravenous fluids, vasopressors, mechanical ventilation, and renal replacement therapy. In the absence of effective therapies specifically targeting the dysregulated immune response, prolonged use of these life-sustaining therapies can be debilitating. A growing body of evidence suggesting that vitamin C, an inexpensive and readily available intervention, is potentially lifesaving in sepsis. Intravenous vitamin C may be the first therapy to mitigate the dysregulated cascade of events that leads to sepsis. If proven effective, vitamin C could be used worldwide and drastically change outcomes in high- and low-income settings alike.

Objectives. To determine whether intravenous vitamin C, compared to placebo, reduces mortality and morbidity in sepsis, and compare clinical and biochemical measures of organ dysfunction, and health-related quality of life (HRQoL) at 6 months. 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 Trial will be conducted in 25 adult general Canadian intensive care units. For the PK substudy: Blood samples will be drawn around the 6th dose (second dose on day 2) 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 3 of the 25 participating centers.

Relevance. In the context of increasing off-label use of vitamin C for sepsis and ongoing trials of vitamin C bundled with other pharmacological interventions, the LOVIT Trial will constitute a rigorous assessment of the effect of vitamin C monotherapy on patient-important outcomes.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 800 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Lessening Organ Dysfunction With VITamin C (LOVIT)
Actual Study Start Date : November 8, 2018
Estimated Primary Completion Date : December 31, 2021
Estimated Study Completion Date : December 31, 2022

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Vitamin C

Arm Intervention/treatment
Experimental: Vitamin C
Vitamin C: 50 mg/kg every 6 hours for 96 hours.
Drug: Vitamin C
Intravenous vitamin C administered in bolus doses of 50 mg/kg mixed in a 50-mL solution of either dextrose 5% in water (D5W) or normal saline (0.9% NaCl), during 30 to 60 minutes, every 6 hours for 96 hours (i.e. 200 mg/kg/day and 16 doses in total).
Other Name: Ascorbic acid

Placebo Comparator: Control
Dextrose 5% in water (D5W) or normal saline (0.9% NaCl) in a volume to match the vitamin C.
Other: Control
Dextrose 5% in water (D5W) or normal saline (0.9% NaCl) in a volume to match the vitamin C.




Primary Outcome Measures :
  1. Number of deceased participants or with persistent organ dysfunction [ Time Frame: Both assessed at 28 days ]
    Defined as death or dependency on mechanical ventilation, renal replacement, or vasopressors


Secondary Outcome Measures :
  1. Number of participants with persistent organ dysfunction-free days in intensive care unit [ Time Frame: Up to day 28 ]
    Persistent organ dysfunction-free days in intensive care unit

  2. Number of participants deceased at 6 months [ Time Frame: 6 months ]
    Mortality at 6 months

  3. Score of health related quality of life in 6-month survivors [ Time Frame: 6 months ]

    Assessed by the questionnaire EuroQol-5D (EQ-5D-5L). The EQ-5D-5L essentially consists of 2 pages: the EQ-5D descriptive system and the EQ visual analogue scale (EQ VAS).

    The descriptive system comprises five 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 his/her health state by ticking the box next to the most appropriate statement in each of the five dimensions. This decision results in a 1-digit number that expresses the level selected for that dimension. The digits for the five 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 analogue scale, where the endpoints are labelled 'The best health you can imagine' and 'The worst health you can imagine'.


  4. Global tissue dysoxia [ Time Frame: Days 1, 3, 7 ]
    Assessed by serum lactate concentration

  5. Organ function (including renal function) [ Time Frame: Days 1, 2, 3, 4, 7, 10, 14, 28 ]
    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 6 different sub-scores, one each for the respiratory (PaO2/FiO2 mmHg), cardiovascular (mean arterial pressure OR administration of vasopressors required), hepatic (liver bilirubin (mg/dl) [μmol/L]), coagulation (platelets×103/µl), renal (kidneys creatinine (mg/dl) [μmol/L] (or urine output)) and neurological (Glasgow coma scale). The sub-score of eah system ranges from 0 (best) to +4 (worst).

  6. Rate of inflammation [ Time Frame: Days 1, 3, 7 ]
    Assessed by interleukin-1 beta (IL-1ß), tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP)

  7. Rate of infection [ Time Frame: Days 1, 3, 7 ]
    Assessed by procalcitonin (PCT)

  8. Rate of endothelial injury [ Time Frame: Days 1, 3, 7 ]
    Assessed by thrombomodulin (TM) and angiopoietin-2 (ANG-2)

  9. Vitamin C volume of distribution [ Time Frame: 6th dose of vitamin C (second dose on day 2) at time 0 (immediately prior to the dose) and then after administration at times 1 hour, 2 hours, 4 hours and 6 hours ]
    Assessed by chromatography-tandem mass spectrometry

  10. Vitamin C clearance [ Time Frame: 6th dose of vitamin C (second dose on day 2) at time 0 (immediately prior to the dose) and then after administration at times 1 hour, 2 hours, 4 hours and 6 hours ]
    Assessed by chromatography-tandem mass spectrometry

  11. Vitamin C plasma concentration [ Time Frame: 6th dose of vitamin C (second dose on day 2) at time 0 (immediately prior to the dose) and then after administration at times 1 hour, 2 hours, 4 hours and 6 hours ]
    Assessed by chromatography-tandem mass spectrometry



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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Admitted to the intensive care unit with proven or suspected infection as the main diagnosis;
  2. Currently treated with a continuous IV infusion of vasopressors (norepinephrine, epinephrine, vasopressin, dopamine, phenylephrine).

Exclusion Criteria:

  1. > 24 hours of intensive care unit admission;
  2. Known Glucose-6-phosphate dehydrogenase (G6PD) deficiency;
  3. Pregnancy;
  4. Known allergy to vitamin C;
  5. Known kidney stones within the past 1 year;
  6. Received any intravenous vitamin C during this hospitalization unless incorporated in parenteral nutrition;
  7. Expected death or withdrawal of life-sustaining treatments within 48 hours;
  8. Previously enrolled in this study;
  9. Previously enrolled in a trial with which co-enrolment is not allowed.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03680274


Contacts
Contact: Marie-Helene Masse 819-346-1110 ext 14173 marie-helene.masse3@usherbrooke.ca
Contact: Marie-Claude Battista, PhD 819-346-1110 ext 12480 marie-claude.battista@usherbrooke.ca

Locations
Canada, Quebec
Research Center of the CHUS Recruiting
Sherbrooke, Quebec, Canada, J1H 5N4
Contact: Marie-Helene Masse    819-346-1110 ext 14173    marie-helene.masse3@usherbrooke.ca   
Contact: Marie-Claude Battista, PhD    819-346-1110 ext 12480    marie-claude.battista@usherbrooke.ca   
Sponsors and Collaborators
Université de Sherbrooke
Lotte & John Hecht Memorial Foundation
Investigators
Principal Investigator: François Lamontagne, MD FRCPC MSc Université de Sherbrooke and CIUSSS de l'Estrie - CHUS
Principal Investigator: Neill Adhikari, MDCM FRCPC MSc Sunnybrook Health Sciences Centre, University of Toronto

Responsible Party: François Lamontagne, Doctor, professor and researcher, Université de Sherbrooke
ClinicalTrials.gov Identifier: NCT03680274     History of Changes
Other Study ID Numbers: MP-31-2019-2945
First Posted: September 21, 2018    Key Record Dates
Last Update Posted: December 21, 2018
Last Verified: December 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:
Vitamins
Ascorbic Acid
Micronutrients
Growth Substances
Physiological Effects of Drugs
Antioxidants
Molecular Mechanisms of Pharmacological Action
Protective Agents