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Pharmacologic Ascorbic Acid as an Activator of Lymphocyte Signaling for COVID-19 Treatment

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
ClinicalTrials.gov Identifier: NCT04363216
Recruitment Status : Unknown
Verified May 2020 by Thomas Jefferson University.
Recruitment status was:  Not yet recruiting
First Posted : April 27, 2020
Last Update Posted : May 5, 2020
Information provided by (Responsible Party):
Thomas Jefferson University

Brief Summary:
There are currently no approved therapies for patients with coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Infusion of ascorbic acid (vitamin C) has been shown to increase activity of lymphocytes, which are a crucial component of the body's defense against viral disease progression and adaptive immunity. Ascorbic acid infusion has been shown to be a safe treatment for patients suffering from sepsis and certain types of cancer. This study is designed to evaluate the safety and efficacy of ascorbic acid in the form of sequential I.V. infusions (Ascor®) for patients with suspected COVID-19 who are unlikely to require mechanical ventilation within 24 hours of study intervention.

Condition or disease Intervention/treatment Phase
COVID-19 Drug: Ascorbic Acid Phase 2

Detailed Description:

Ascorbic acid [AA] (vitamin C) is an essential nutrient that, in addition to aiding tissue repair, also functions as an enzyme co-factor, an antioxidant, and a key component in lymphocyte development and function. Lymphocytes are responsible for adaptive immunity, the immune response following vaccination, in addition to playing a vital role in protection against viral disease progression. Both sepsis and aberrant lymphocyte activation have been associated with severe AA deficiency. We hypothesize that the administration of increasing concentrations of pharmacologic AA promotes lymphocyte activation and signaling in newly admitted, non-ventilator dependent COVID-19 patients via hydrogen peroxide generation and/or DNA de-methylation, and that this will lead to improved clinical outcomes.

This is a single-center, prospective, randomized, open-label, phase II clinical trial designed to assess the efficacy, tolerability, and safety of pharmacologic AA administration in hospitalized patients newly-diagnosed with COVID-19 who will likely not require mechanical ventilation within 24 hours of study intervention. All subjects enrolled will be pending inpatient admission or already admitted as they will require supplemental oxygen. Within 12 hours of admission to the E.D. or medical/surgical floor (rapid screens to determine eligibility must be completed within this time), patients will receive escalating pharmacologic AA over 2 hours once daily for 3 escalating doses, then continued on the highest dose for a total of 6 infusions.

Subjects will be randomized 2:1, with 66 subjects receiving AA treatments and 22 subjects receiving routine clinical care. The open-label design allows investigators to evaluate the safety and clinical progress in real-time. Any subject randomized to AA treatment who is upgraded to ICU-level care, requires high-flow O2 supplementation, or is intubated, will no longer receive AA infusions in order to maximize patient safety during this study. Given the robust safety data on the treatment, a phase II design was chosen with an interim safety analysis after 21 patients. Randomization will be stratified according to high vs. low risk of complications. Patients will be considered to be high risk if they have any of the following characteristics: age>60, hypertension, structural lung disease, cardiovascular disease, diabetes, immunocompromising conditions or meds (such as immunosuppressing meds in transplant patients).

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 66 participants
Allocation: Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Pharmacologic Ascorbic Acid as an Activator of Lymphocyte Signaling for COVID-19 Treatment
Estimated Study Start Date : May 2020
Estimated Primary Completion Date : May 2021
Estimated Study Completion Date : May 2021

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Treatment
Ascorbic acid solution (Ascor®, McGuff Pharmaceuticals, Ltd.) will be added to each liter of sterile wate,r plus 1 g/L magnesium chloride to reduce burning sensation, and given parenterally over a 2-hour period. On the day of enrollment (Day 0), 0.3 g/kg will be given; Day 1 - 0.6 g/kg; Day 2 - 0.9 g/kg; Day 3 - 0.9 g/kg; Day 4 - 0.9 g/kg; Day 5 - 0.9 g/kg. After the first dose, each subsequent dose will be given 24 +/- 4 hours following the previous dose.
Drug: Ascorbic Acid
Ascor® ascorbic acid 2-hour infusion daily (for 6 days), escalating dose (0.3g/kg, 0.6g/kg, 0.9g/kg).
Other Name: Vitamin C

No Intervention: Routine care
These subject will follow routine care and their clinical courses will be recorded only.

Primary Outcome Measures :
  1. Clinical Improvement [ Time Frame: 72 hours ]
    • Clinical improvement at 72 hours of treatment, defined as a 50% reduction in the highest flow rate of oxygen during the 72 hour period, a 50% reduction in the most frequent use of bronchodilators within a 12-hour window within the 72-hour period, or hospital discharge (whichever comes first).

Secondary Outcome Measures :
  1. Patient status upgraded to ICU level [Clinical decline] [ Time Frame: 36 hours ]
    Subject is upgraded to ICU-level care

  2. Oxygen supplementation [ Time Frame: up to 1 year ]
    Overall rate of oxygen supplementation in L/min

  3. Days with fever [ Time Frame: up to 1 year ]
    Number of days during hospitalization where a fever (>100.4°F) is reached at least once

  4. Days to discharge [ Time Frame: up to 1 year ]
    Number of days from initial treatment to hospital discharge

  5. SAEs [ Time Frame: up to 1 year ]
    Serious adverse events specific to treatment

Information from the National Library of Medicine

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

Inclusion Criteria:

  1. Male or non-pregnant female > 18 years of age at the time of consent
  2. ConfirmedSARS-CoV-2 infection
  3. Disease severity necessitating hospitalization
  4. Currently taking supplemental oxygen
  5. No anticipated need (within 24 hours) for mechanical ventilation, defined as:

    1. Positive clinical response to oxygen supplementation with improvement in hypoxia or
    2. Hypoxia improvement with bronchospasm therapy if bronchospasm present

Exclusion Criteria

  1. eGFR < 50
  2. Known Glucose-6-phosphate dehydrogenase (G6PD) deficiency
  3. Anticipated need for mechanical ventilation within 24 hours
  4. Pregnant or breastfeeding
  5. Requires home oxygen for any reason

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): NCT04363216

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Contact: Michael W Foster, M.D. 6107160962 mxf314@jefferson.edu
Contact: Melissa McCarey 267 503-7417 melissa.mccarey@jefferson.edu

Sponsors and Collaborators
Thomas Jefferson University
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Principal Investigator: Dagan Coppock, M.D. Thomas Jefferson University
Study Director: Daniel Monti, M.D. Thomas Jefferson University
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Responsible Party: Thomas Jefferson University
ClinicalTrials.gov Identifier: NCT04363216    
Other Study ID Numbers: JT#15681
First Posted: April 27, 2020    Key Record Dates
Last Update Posted: May 5, 2020
Last Verified: May 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Thomas Jefferson University:
ascorbic acid
vitamin c
Additional relevant MeSH terms:
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Pneumonia, Viral
Respiratory Tract Infections
Virus Diseases
Coronavirus Infections
Coronaviridae Infections
Nidovirales Infections
RNA Virus Infections
Lung Diseases
Respiratory Tract Diseases
Ascorbic Acid
Physiological Effects of Drugs
Molecular Mechanisms of Pharmacological Action
Protective Agents