Intravenous Vitamin C — A Treatment Hospitals Don’t Want?

Aim of the study: Intravenous vitamin C (IVC) is a contentious adjunctive cancer therapy, widely used in naturopathic and integrative oncology settings. We conducted a systematic review of human interventional and observational studies assessing IVC for use in cancer patients.

Results: Of 897 records, a total of 39 reports of 37 studies were included: 2 randomized controlled trials (RCTs), 15 uncontrolled trials, 6 observational studies, and 14 case reports. IVC dosing ranged from 1 g to more than 200 g ascorbic acid per infusion, typically administered 2 to 3 times weekly. IVC does not appear to increase toxicity or interfere with the antitumor effects of gemcitabine/erlotinib therapy or paclitaxel and carboplatin. Based on 1 RCT and data from uncontrolled human trials, IVC may improve time to relapse and possibly enhance reductions in tumor mass and improve survival in combination with chemotherapy. IVC may improve quality of life, physical function, and toxicities associated with chemotherapy, including fatigue, nausea, insomnia, constipation, and depression. Case reports document several instances of tumor regression and long-term disease-free survival associated with use of IVC. There is limited high-quality clinical evidence on the safety and effectiveness of IVC.

Aim of the study: Vitamin C is known to support immune function and is accumulated by neutrophils to millimolar intracellular concentrations, suggesting an important role for the vitamin in these cells. In this review, the effects of vitamin C, as a mono- or multi-supplement therapy, on neutrophil function were assessed by conducting a systematic review of randomized controlled trials (RCTs).

Results: Overall, 44% of the RCTs assessed in this review showed effects of vitamin C supplementation on neutrophil functions. However, the studies were very heterogeneous, comprising different participant cohorts and different dosing regimens. There were also a number of limitations inherent in the design of many of these RCTs. Future RCTs should incorporate prescreening of potential participants for low vitamin C status or utilize cohorts known to have low vitamin status, such as hospitalized patients, and should also comprise appropriate vitamin C dosing for the cohort under investigation.

Aim of the study: Patients with metastatic pancreatic ductal adenocarcinoma (PDAC) have poor 5-year survival. Pharmacological ascorbate (P-AscH-, high dose, intravenous vitamin C) has shown promise as an adjunct to chemotherapy. We hypothesized that adding P-AscH- to gemcitabine and nab-paclitaxel would increase survival in patients with metastatic PDAC.

Results: Intravenous P-AscH- increased serum ascorbate levels from micromolar to millimolar levels. P-AscH- added to gemcitabine + nab-paclitaxel (ASC) increased overall survival to 16 months compared with 8.3 months with gemcitabine + nab-paclitaxel (SOC) (HR = 0.46; 90 % CI 0.23, 0.92; p = 0.030). Median progression-free survival was 6.2 (ASC) vs. 3.9 months (SOC) (HR = 0.43; 90 % CI 0.20, 0.92; p = 0.029). Adding P-AscH- did not negatively affect quality of life or increase the frequency or severity of adverse events. P-AscH- infusions of 75 g three times weekly in patients with metastatic pancreatic cancer prolong overall and progression-free survival without detriment to quality of life or added toxicity (ClinicalTrials.gov number NCT02905578).

Aim of the study: The global burden of sepsis is estimated as 15 to 19 million cases annually, with a mortality rate approaching 60% in low-income countries.

Results: There were 47 patients in both the treatment and control groups, with no significant differences in baseline characteristics between the two groups. Hospital mortality was 8.5% (4 of 47) in the treatment group compared with 40.4% (19 of 47) in the control group (P < .001). The propensity-adjusted odds of mortality in patients treated with the vitamin C protocol was 0.13 (95% CI, 0.04-0.48; P = .002). The Sepsis-Related Organ Failure Assessment score decreased in all patients in the treatment group, with none developing progressive organ failure. All patients in the treatment group were weaned off vasopressors, a mean of 18.3 ± 9.8 h after starting treatment with the vitamin C protocol. The mean duration of vasopressor use was 54.9 ± 28.4 h in the control group (P < .001).

Aim of the study: Previous studies mentioned the beneficial effects of vitamin C on hemorrhage and wound healing. We evaluated the effects of vitamin C on hemorrhage, hemoglobin concentration, and wound complications in total abdominal hysterectomy.

Results: The mean age of the participants was 37.8 ± 4.8 years, with a mean preoperative plasma vitamin C concentration of 5.07 ± 2.1 mg/dL, close to subclinical deficiency. The baseline characteristics of both groups were the same. The hemorrhage volume was slightly higher in the control group (345.2 ± 31.8 ml vs. 388.1 ± 28.3 ml, P < 0.001). Intravenous vitamin C administration had a positive effect on reducing hemorrhage during total abdominal hysterectomy.

Aim of the study: Chikungunya is a viral illness characterized by severe joint pain, which may persist for months to years. There is no effective treatment for this disease.

Results: We treated 56 patients with moderate to severe persistent pain with a single infusion of ascorbic acid ranging from 25-50 grams and hydrogen peroxide (3 cc of a 3% solution) from July to October 2014. Patients were asked about their pain using the Verbal Numerical Rating Scale-11 immediately before and after treatment. The mean pain score before and after treatment was 8 and 2 respectively (60%) (p < 0.001); and 5 patients (9%) had a pain score of 0. The use of intravenous ascorbic acid and hydrogen peroxide resulted in a statistically significant reduction in pain in patients with moderate to severe pain from the Chikungunya virus immediately after treatment.

Aim of the study: Cerebrovascular endothelial function can be assessed by measuring the shear-mediated dilation or cerebrovascular reactivity (CVR) of the internal carotid artery (ICA) in response to transient hypercapnia (30 s). ICA CVR is blunted with aging; however, it is not known whether age-related reductions in ICA CVR are influenced by antioxidant-responsive mechanisms.

Results: The primary analytic sample included nine Y adults (25 ± 2 years) and nineteen (65 ± 6 years) MA/O adults, with analyzable data varying by outcome. ICA CVR was measured using high-resolution duplex ultrasound, and MCA CVR was measured using transcranial Doppler ultrasound. AA infusion improved ICA CVR and MCA CVR in MA/O adults but had no effect in Y adults. These findings suggest that age-related impairments in cerebrovascular function may be partly attributable to mechanisms responsive to acute, supraphysiological AA administration.