Supplements: Singaporean Researchers Say That Vitamin D, Magnesium And Vitamin B12 Combo May Reduce Severity In Older COVID-19 Patients
: Medical researchers from Singapore General Hospital lead by Professor Dr Heng Joo Ng from the Department of Hematology, SGH have recently published a preprint study that has been yet to be peer-reviewed that shows a combination of easily available and cheap dietary supplements such as Vitamins D3, B12 and the mineral magnesium can reduce the progression of the disease to severe or fatal stages. The supplement combo known as DMB was also useful for older patients. https://www.medrxiv.org/content/10.1101/2020.06.01.20112334v1.full.pdf+html
The present hypothesis on the pathogenesis of the condition is that hyperinflammation plays a crucial role in patient outcomes. This means that direct viral injury is not the only or even primary player in organ dysfunction related to COVID-19. Rather, it is the result of the organ toxicity caused by the unregulated release of pro-inflammatory cytokines like IL-6 and IL-8, in response to the immune induction by the virus.
Hence immunomodulation is an attractive option in the treatment of COVID-19 and may prevent the progression of the patient to severe or critical illness. Various biologic molecules have been tried, such as the IL-6 blocker tocilizumab which is very costly.
The Singaporean study was an observational cohort study of a consecutive series of hospitalized COVID-19 patients aged 50 years and above, who were given the DMB protocol ie the combination of the above micronutrients, comparing the rate of progression of disease in this group to another cohort of patients who were not given the DMB protocol.
It is known that Vitamin D protects the respiratory epithelium structure and function.
Magnesium promotes vitamin D functions, acting as a cofactor in multiple enzymes involved in vitamin D metabolism, while also having independent bronchodilator and vasodilator activity.
Whereas Vitamin B12 improves the health of the gut bacteria, which in turn is vital for an active and effective immune system. All these supplements are safe and well-tolerated by patients.
The medical researchers aimed at testing the effect of a short course of supplementation of DMB in COVID-19 patients who are not yet in the severe or critical phase of the illness. The aim was to find out if this could prevent poor patient outcomes.
The research study included all patients with COVID-19 who were at least 50 years old, admitted to Singapore General Hospital, between 15 January and 15 April 2020. All of them had a positive RT-PCR test. The study outcome was to assess how many progressed to need oxygen in any mode, or intensive care unit (ICU) admission.
The research was such that from 6 April 2020, all patients fitting these criteria were administered DMB and formed the study cohort. DMB consisted of one daily dose of vitamin D3 1000 IU, magnesium 150mg, and vitamin B12 500mcg for up to 14 days. It was stopped if the patient either recovered symptomatically and two successive PCR tests were negative, or if the patient deteriorated clinically.
Majority patients in the study arm received DMB on the first day of admission and had continued therapy for 5 days (median).
e COVID-19 patients admitted in the same period but who did not receive the DMB protocol were the controls. The study arm comprised 17 patients while the control arm had 26 patients, both arms being similar concerning demographics, and clinical features.
Results Of The DMB Protocol.
The medical researchers found that only 3/17 patients in the study arm required supplemental oxygen, compared to 16/26 in the control group.
In both groups, the requirement for oxygen also signaled a high risk for ICU, with 2/3 in the DMB group and 16/16 in the non-DMB group requiring ICU admission. Of the 3 patients in the DMB group who deteriorated, one needed oxygen supplementation after 3 days on DMB but remained stable on the ward.
Interestingly of the 9 patients who received early DMB (in the first week of hospitalization), only one deteriorated, being among the 2, which required oxygen early (within 24 hours of starting DMB). These 2 are likely to have already gone downhill, judging from their rapid deterioration, and the DMB was probably too late to affect events either way.
The study analysis showed that the odds of requiring oxygen went up with age and the presence of other illnesses, but went down significantly with DMB treatment, even after adjusting for age, gender, and other illnesses. The odds would have been even more impressive if the two patients who received DMB late in their clinical course were excluded. Importantly, there were no adverse effects that could be traced to DMB.
Procured data from around the world shows that up to a fifth of COVID-19 patients experience life-endangering complications. IL-6 blockers and anti-thrombotic agents may be little better than a Band-aid in this situation, addressing the late events and mostly ineffective. However, the current study sought to make use of pre-emptive immunoregulatory, safe, and well-tolerated agents to reduce the cytokine storm associated with terminal organ damage and death.
The witnessed success of this strategy could allow it to be adopted as a safe, easily administered, and early intervention in the primary care setting. It could also be equally effectively used to prevent symptomatic or severe disease among high-risk contact clusters traced during an outbreak. It is extremely cost-effective, making it suitable for low- and middle-income countries, even when vaccines or therapeutic drugs may be too costly to afford.
Significantly the use of the DMB protocol may be equally effective in other viral infections that also produce high levels of cytokines and thus cause injury independent of the direct tissue injury.
According to the researchers, limitations of the study are that the small sample size and the absence of biologic assays to support the clinical improvement in the study cohort. However, the team concludes, “It is a proof-of-principle effort with very promising results. The research findings would need to be further validated in a well-designed randomized clinical study.”
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