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This transcript has been edited for clarity.
Welcome Impact factor, Your weekly commentary on new medical research. Dr. F. Perry Wilson, Yale University School of Medicine.
Wouldn’t it be great if shareholders could see the treatment of COVID-19, which is safe, effective, cheap, and out of the control of faceless pharmaceutical executives? The dream of such a magic bullet has led to many similar claims that a given drug (or supplement in some cases) has a dramatic effect on COVID-19.We first saw it with hydroxychloroquine, but it was surrounded by similar hype Vitamin D, Ivermectin, Melatonin, Vitamin C, and of course, zinc..
There were two things that made the claim very compelling. One was a biologically valid dose.Biologists can argue that there were some underlying reasons why The vitamins given usually help, citing beneficial effects on immune function or a decrease in inflammatory cytokines. But more than that, there was talk of the weak with these drugs. These unpretentious agents who have been with us for decades or more could be our most powerful ally against the tragedy of this virus. Preliminary data was often breathtakingly hyped, As pointed out about vitamin D, We have been burned before. Many of us wanted to see randomized trials before tackling any of these potential treatments.
this week, We had one such trialAppeared in JAMA network open, Investigate the ability of zinc and vitamin C alone or in combination to reduce COVID-19 symptoms in outpatients.
As you can see here, this was a 2 x 2 factorial plan. Patients were randomized in much the same way to regular care or one of three treatment groups.
Since these were outpatients, we did not see many difficult results. Rather, researchers used a rank-based symptom scoring method. Participants were asked daily about four symptoms and evaluated on a scale of 0 to 3, with symptom scores ranging from 0 to 12. The main result was the time it took for the symptom score to be halved. In other words, if you start with 4, it’s the time it takes to reach 2. Or, if you start at 10, it’s the time it takes to reach 5. This is a bit strange result because I’m assuming it’s mathematically equivalent, but I think it’s as good as possible. ..
Symptoms over time for the entire study cohort are: You can see the general decline of moderate symptoms (yellow) in favor of mild symptoms (green).
Thomas S et al. JAMA network opened. 2021; 4: e210369. doi: 10.1001 / jamanetworkopen.2021.0369
However, when stratified by treatment, the time to 50% reduction in symptoms was essentially the same overall. Depending on that, it is about 5.5 to 6.5 days.
Thomas S et al. JAMA network opened. 2021; 4: e210369. doi: 10.1001 / jamanetworkopen.2021.0369
There are no individual symptoms that resolve faster with zinc, vitamin C, or combos. Basically, the population has come to our expectations: fever for several days, prolonged coughing and malaise.
Hospitalization rates were slightly higher in the supplement group, but not significantly different. Thankfully, only three people died. One was a vitamin C group and two were a combo group.
There was nothing crazy about the side effects. But apparently, the authors saw more in the treatment group than in the regular care group, primarily GI.
Now, the zinc apologist will definitely notice the lack of zinc ionophore ( Chloroquine Or pyrithione) As the reason why this didn’t work. Again, it reminds you that biological validity is the beginning, not the end of medical research. It is not an end in itself, but the minimum standard to pass to conduct an ethically definitive trial. We will read aloud the imminent hydroxychloroquine-zinc combo randomized trials that occur.
More broadly, I think we need to accept the fact that COVID treatments are fairly unlikely to be in the closet. Many chemicals are active against in vitro pathogens, just as many act in vitro against cancer. However, this test reminds us that biologically promising drugs often cannot tolerate the rigors of actual testing. I will continue to have hope, but please bring the data.
F. Perry Wilson, MD, MSCE, is an Associate Professor of Medicine and Director of Clinical and Translational Research Accelerators at Yale University. His science communication work can be found at the Huffington Post, NPR, and here in Medscape.He tweets @fperrywilson Host a repository of his communication work at www.methodsman.com..
