USA: Treatment with vitamin C, thiamine, and hydrocortisone does not significantly improve ventilator- and vasopressor-free days compared to placebo in critically ill patients, finds a recent study in the journal JAMA. However, a clinically important difference could not have been detected as the trial was terminated early for administrative reasons and may have been underpowered.
Sepsis, body's extreme response to an infection, is a common life-threatening emergency with substantial morbidity and mortality. A combination of thiamine, vitamin C, and corticosteroids has been proposed as a potential treatment for sepsis patients. Jonathan E. Sevransky, Emory University School of Medicine, Atlanta, Georgia, and colleagues aimed to determine whether a combo of these three every 6 hours increases ventilator- and vasopressor-free days compared with placebo in patients with sepsis.
For the purpose, the researchers performed a multicenter, randomized, double-blind, adaptive-sample-size, placebo-controlled trial. The trial was conducted in adult patients with sepsis-induced respiratory and/or cardiovascular dysfunction.
The study included participants enrolled in the emergency departments or intensive care units at 43 hospitals in the US between August 2018 and July 2019. After enrollment of 501 participants, funding was withheld, leading to an administrative termination of the trial. All study-related follow-up was completed by January 2020.
The participants were randomized to receive intravenous vitamin C (1.5 g), thiamine (100 mg), and hydrocortisone (50 mg) every 6 hours (n = 252) or matching placebo (n = 249) for 96 hours or until discharge from the intensive care unit or death.Participants could be treated with open-label corticosteroids by the clinical team, with study hydrocortisone or matching placebo withheld if the total daily dose was greater or equal to the equivalent of 200 mg of hydrocortisone.
The primary outcome was the number of consecutive ventilator- and vasopressor-free days in the first 30 days following the day of randomization. The key secondary outcome was 30-day mortality.
Key findings of the study include:
Open-label corticosteroids were prescribed to 33% and 32% of the intervention and control groups, respectively.
Ventilator- and vasopressor-free days were a median of 25 days (IQR, 0-29 days) in the intervention group and 26 days (IQR, 0-28 days) in the placebo group, with a median difference of −1 day.
Thirty-day mortality was 22% in the intervention group and 24% in the placebo group.
"Among critically ill patients with sepsis, treatment with vitamin C, thiamine, and hydrocortisone, compared with placebo, did not significantly increase ventilator- and vasopressor-free days within 30 days. However, the trial was terminated early for administrative reasons and may have been underpowered to detect a clinically important difference," wrote the authors.
The study titled, "Effect of Vitamin C, Thiamine, and Hydrocortisone on Ventilator- and Vasopressor-Free Days in Patients With Sepsis: The VICTAS Randomized Clinical Trial," is published in the journal JAMA.
DOI: https://jamanetwork.com/journals/jama/fullarticle/2776688