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Recruitment failure
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The NUTROVID Factorial Trials
The purpose of the NUTROVID-Prevent and NUTROVID-Treat Factorial Trials is to determine whether Vitamin B Complex, Vitamin C, and Zinc; Vitamin D; and Omega3, taken at dosages approximating recommended dosages, can reduce the risk of COVID-19 infection, hospitalization, mortality.
Inadequate vitamin intake is common in Mexico. Vitamin deficiency is hypothesized as a risk factor for COVID-19 infection and severe outcomes. Specifically, Vitamin D has been hypothesized as a regulator of the inflammatory cytokine response; Vitamin C may help reduce the risk of a cytokine storm and support the immune system; Vitamin B reduces pro-inflammatory cytokine levels, helps improve respiratory function, reduces hypercoagulability, and promotes endothelial structural integrity; Resolvins, derived from Omega3s, are a type of specialized pro-resolving lipid autacoid mediators hypothesized to prevent cytokine storms. Elemental Zinc is hypothesized to inhibit the replication of viruses.
The NUTROVID-Prevent and NUTROVID-Treat Factorial Trials are testing the efficacy of these supplements (Vitamins B, C, D, Zinc, and Omega 3) when used over a 60 day period among those who test positive (Treat) and negative (Prevent) for SARS-COV-2 via a PCR test.
The NUTROVID Trials utilize an innovative and cost-efficient approach, leveraging the existing infrastructure of the hospital system in San Luis Potosà province of Mexico. For NUTROVID-Treat, we aim to enroll ~1,800 adults who have recently tested positive for SARS-Cov-2 and who have given informed consent. These ~1,800 adult females and males age 18 or older will be enrolled and randomized into the NUTROVID Treat Factorial Trial's 2x2x2 arms, in which 50% of the population will have a chance to receive any combination of the 3 supplement formulations; the other 50% will receive the respective placebos.
Those who test negative will be randomized into the NUTROVID-Prevent Factorial Trial's 2x2x2 arms, in which 50% of the population will have a chance to receive any combination of the 3 supplement formulations; the other 50% will receive the respective placebos. For NUTROVID-Prevent, we also aim to recruit ~1,800 adults, females and males.
Hospital staff will review medical records for vital events and conduct patient and family follow-up until ~November 2021.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 1 - Vitamin D, Omega 3, Vitamins B, C, Zinc | Active Comparator | Vitamin D of F1 Omega 3 of F2 Vitamins B, C, Zinc of F3 [60 days] |
|
| 2 - Vitamin D, Omega 3 | Active Comparator | Vitamin D of F1 Omega 3 of F2 Placebo of F3 [60 days] |
|
| 3 - Vitamin D, Vitamins B, C, Zinc | Active Comparator | Vitamin D of F1 Placebo of F2 Vitamins B, C, Zinc of F3 [60 days] |
|
| 4 - Vitamin D | Active Comparator | Vitamin D of F1 Placebo of F2 Placebo of F3 [60 days] |
|
| 5 - Omega 3, Vitamins B, C, Zinc, | Active Comparator | Placebo of F1 Omega 3 of F2 Vitamins B, C, Zinc of F3 [60 days] |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Vitamin D | Dietary Supplement | Daily 4000 IU Vitamin D for 60 days |
|
| Measure | Description | Time Frame |
|---|---|---|
| Covid infection rate (PREVENT Trial only) | 1.a. Incidence of positive PCR at ~1 month and ~2 months; 1.b. Incidence of symptomatic positive PCR and asymptomatic positive PCR at 1 month and 2 months. | 30 and 60 days |
| Incidence of severe outcome (TREAT Trial only) | 1.a. Incidence of severe outcome (mortality or ICU admission or intubation) up to 30 days. 1.b. Incidence of severe outcome (mortality or ICU admission or intubation) from 30-60 days. 1.c. Incidence of severe outcome (mortality or ICU admission or intubation), from 30 days to ~ November 2021. 1.d. Incidence of severe outcome (mortality or ICU admission or intubation), from 60 days to ~ November 2021. | 1.a. 1-30 days; 1.b. 30-60; 1.c. 30 days to ~November 2021; 1.d. 60 days to ~ November 2021 |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of hospitalization and death (PREVENT Trial only) | 2.a. Incidence of hospitalization, follow-up to ~ November 2021. 2.b. Incidence of severe outcome (mortality or ICU admission or intubation), follow-up to ~November 2021. 2.c. Incidence of death, follow-up to ~November 2021. | 1-10 months |
| Length of hospitalization and death after discharge (TREAT Trial only) |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in HbA1c (PREVENT Trial only) | Change in HbA1c at 1 month and 2 months | 1-30; 1-60 days |
| Change in diabetes status (PREVENT Trial only) | Change in diabetes status at 1 month and 2 months |
Positive SARS-CoV-2 Test group (Target enrollment: N=1,800) NUTROVID Treat Trial: Adult men/women recently diagnosed with COVID-19 (positive PCR test for SARS-CoV-2 coronavirus) within <=5 days of symptom onset; and satisfying one of these risk factors: >=50 years old; or Diabetic & >=40 years old; or Obese & >=40 years old.
Negative SARS-CoV-2 Test group (Target enrollment: N=1,800) NUTROVID Prevent Trial: Adult men/women recently tested negative for COVID-19 (negative PCR test for SARS-CoV-2 coronavirus); and satisfying one of these risk factors: >=50 years old; or Diabetic & >=40 years old; or Obese & >=40 years old.
Signed Informed Consent Form
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| José Yañez | General Hospital Soledad | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital de Soledad | San Luis Potosà City | San Luis Potosà | 78435 | Mexico |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32603576 | Background | Laird E, Rhodes J, Kenny RA. Vitamin D and Inflammation: Potential Implications for Severity of Covid-19. Ir Med J. 2020 May 7;113(5):81. | |
| 32322486 | Background | Boretti A, Banik BK. Intravenous vitamin C for reduction of cytokines storm in acute respiratory distress syndrome. PharmaNutrition. 2020 Jun;12:100190. doi: 10.1016/j.phanu.2020.100190. Epub 2020 Apr 21. |
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| ID | Term |
|---|---|
| D000086382 | COVID-19 |
| D000080424 | Cytokine Release Syndrome |
| ID | Term |
|---|---|
| D011024 | Pneumonia, Viral |
| D011014 | Pneumonia |
| D012141 | Respiratory Tract Infections |
| D007239 | Infections |
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| ID | Term |
|---|---|
| D014807 | Vitamin D |
| D001205 | Ascorbic Acid |
| D014803 | Vitamin B Complex |
| D019345 | Zinc Acetate |
| ID | Term |
|---|---|
| D012632 | Secosteroids |
| D013256 | Steroids |
| D000072473 | Fused-Ring Compounds |
| D011083 | Polycyclic Compounds |
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Double-blind randomized, placebo-controlled double blinded 2x2x2 factorial trials (includes 2 trials: treatment cohort and prevention cohort) of the following oral supplementation treatments for up to 60 days per person:
Factorial 1 (F1): 4000 IU Vitamin D vs placebo Factorial 2 (F2): 1000mg Omega DHA/EPA vs. placebo Factorial 3 (F3): Combination 1000 mg Vitamin C, Vitamin B complex** and Zinc Acetate, 100 mg/day vs. placebo
**(Vitamin B complex components: B12=1 mg; B6=50 mg; B9=2.5 mg; B1
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| 6 - Omega 3 | Active Comparator | Placebo of F1 Omega 3 of F2 Placebo of F3 [60 days] |
|
| 7 - Vitamins B, C, Zinc | Active Comparator | Placebo of F1 Placebo of F2 Vitamins B, C, Zinc of F3 [60 days] |
|
| 8 - No Interventions | Placebo Comparator | Placebo of F1 Placebo of F2 Placebo of F3 [60 days] |
|
| Omega DHA / EPA | Dietary Supplement | Daily 1000mg Omega DHA/EPA for 60 days |
|
| Vitamin C, Vitamin B complex and Zinc Acetate | Dietary Supplement | Combination 1000 mg Vitamin C, Vitamin B complex** and Zinc Acetate, 100 mg/day for 60 days **(Vitamin B complex components: B12=1 mg; B6=50 mg; B9=2.5 mg; B1=100 mg; B2=100 mg; B3=14 mg; B7=50 mg) |
|
| Placebo | Other | Placebo |
|
2.a. Length of hospitalization for admissions less than 30 days from baseline versus for admissions after 30 days from baseline. 2.b. [If available] Incidence of hospital readmission after discharge, follow-up to ~November 2021. 2.c. Incidence of death after discharge, follow-up to ~November 2021. |
| 2.a. 1-30 days; 2.b. 1 day(s) to ~November 2021, 2.c. 30 days to ~November 2021 |
| 1-30; 1-60 days |
| Change in weight (PREVENT Trial only) | Change in weight at 1 month and 2 months | 1-30; 1-60 days |
| Incidence of COVID -19 symptoms at 1 month and 2 months (PREVENT Trial only) | [If available] Incidence of COVID -19 symptoms at 1 month and 2 months | 1-30; 1-60 days |
| Incidence of hospital readmission (PREVENT Trial only) | [If available] Incidence of COVID -19 symptoms at 1 month and 2 months with follow-up to ~November 2021 | 1-30; 1-60 days; 1 day to ~November 2021 |
| Incidence of ICU admission (PREVENT Trial only) | [If available] Incidence of ICU admission (PREVENT Trial only) | 1-30; 1-60 days; 1 day to ~November 2021 |
| Incidence of intubation (PREVENT Trial only) | [If available] Incidence of intubation (PREVENT Trial only) | 1-30; 1-60 days; 1 day to ~November 2021 |
| Incidence of Vaccination (PREVENT Trial only) | [If available] Incidence of vaccination | 1-30; 1-60 days; 1 day to ~November 2021 |
| Change in HbA1c at 1 month and 2 months (TREAT Trial only) | [If available] Change in HbA1c at 1 month and 2 months. | 1-30 days and 1-60 days |
| Change in diabetes status at 1 month and 2 months (TREAT Trial only) | [If available] Change in diabetes status at 1 month and 2 months. | 1-30 days and 1-60 days |
| Change in weight at 1 month and 2 months (TREAT Trial only) | [If available] Change in weight at 1 month and 2 months | 1-30 days and 1-60 days |
| Incidence of COVID -19 symptoms at 1 month and 2 months (TREAT Trial only) | [If available] Incidence of COVID -19 symptoms at 1 month and 2 months. | 1-30 days and 1-60 days |
| Incidence of depression (TREAT Trial only) | [If available] Incidence of depression | ~1-60 days |
| Incidence of vaccination (TREAT Trial only) | [If available] Incidence of vaccination | 1-30; 1-60 days; 1 day to ~November 2021 |
| Incidence of vaccine hesitancy (TREAT Trial only) | [If available] Incidence of vaccine hesitancy | ~1-60 days |
| ICU readmission (TREAT Trial only) | [If available] ICU readmission | 1-30; 1-60 days; 1 day to ~November 2021 |
| Incidence of Intubation (upon readmission) (TREAT Trial only) | [If available] Incidence of Intubation | 1-30; 1-60 days; 1 day to ~November 2021 |
| 32385712 | Background | Panigrahy D, Gilligan MM, Huang S, Gartung A, Cortes-Puch I, Sime PJ, Phipps RP, Serhan CN, Hammock BD. Inflammation resolution: a dual-pronged approach to averting cytokine storms in COVID-19? Cancer Metastasis Rev. 2020 Jun;39(2):337-340. doi: 10.1007/s10555-020-09889-4. |
| 32829981 | Background | Shakoor H, Feehan J, Mikkelsen K, Al Dhaheri AS, Ali HI, Platat C, Ismail LC, Stojanovska L, Apostolopoulos V. Be well: A potential role for vitamin B in COVID-19. Maturitas. 2021 Feb;144:108-111. doi: 10.1016/j.maturitas.2020.08.007. Epub 2020 Aug 15. No abstract available. |
| 32871238 | Background | Entrenas Castillo M, Entrenas Costa LM, Vaquero Barrios JM, Alcala Diaz JF, Lopez Miranda J, Bouillon R, Quesada Gomez JM. "Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study". J Steroid Biochem Mol Biol. 2020 Oct;203:105751. doi: 10.1016/j.jsbmb.2020.105751. Epub 2020 Aug 29. |
| 23775705 | Background | Singh M, Das RR. Zinc for the common cold. Cochrane Database Syst Rev. 2013 Jun 18;(6):CD001364. doi: 10.1002/14651858.CD001364.pub4. |
| D014777 |
| Virus Diseases |
| D018352 | Coronavirus Infections |
| D003333 | Coronaviridae Infections |
| D030341 | Nidovirales Infections |
| D012327 | RNA Virus Infections |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D018746 | Systemic Inflammatory Response Syndrome |
| D007249 | Inflammation |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D012769 | Shock |
| D013400 |
| Sugar Acids |
| D000144 | Acids, Acyclic |
| D002264 | Carboxylic Acids |
| D009930 | Organic Chemicals |
| D006880 | Hydroxy Acids |
| D002241 | Carbohydrates |
| D014815 | Vitamins |
| D018977 | Micronutrients |
| D045505 | Physiological Effects of Drugs |
| D020228 | Pharmacologic Actions |
| D020164 | Chemical Actions and Uses |
| D019342 | Acetic Acid |
| D000085 | Acetates |