Unexpected hope may be within reach for patients who suffer from certain early blood diseases despite a relatively simple daily supplement. In a carefully controlled phase 2 study, called EVITA, researchers reported that patients receiving a daily dose of 1,000 milligrams of oral vitamin C died quite a bit less often than patients who received a placebo during nearly three years of follow up. Although the findings, reported in the journal Cancer, do not establish vitamin C administration as an effective treatment, they do provide a beacon of hope that is worth rigorous study.
The trial included 109 adults with clonal cytopenia of undetermined significance or lower-risk myeloid malignancies from Denmark and the US. Clonal cytopenic of undetermined significance and lower risk myeloid malignancies are conditions where abnormal, bleisty blood cell clones develop and the patient produces fewer healthy blood cells. They may remain unchanged for many years or slowly develop into higher stage blood cancers like acute myeloid leukemia. Patients were randomized to receive either the C supplement or placebo for 12 months. Patients and researchers was blinded to study arm allocated.
The main aim of this trial was to determine if vitamin C had an effect on the rate of spread of the abnormal cell clones. In regard to this endpoint both groups were fairly comparable. The rate of rapid growth of the abnormal cell clones did not differ between the treated and placebo groups. So the trial failed to meet its primary endpoint. Though, the secondary endpoints showed quite contrasting results.
Eighteen months after class enrollment, with a median follow-up of 33.6 months, there were a total of 35 deaths in the entire population. Twenty-four of those deaths occurred among the placebo takers and only eleven in the vitamin C takers; an exploratory analysis also found that the added vitamin C Really reduced the risk of death. Study subjects receiving vitamin C experienced fewer serious health problems during the treatment year and long-term, including less, anemia, pneumonia, joint, inflammation, and internal bleeding. Gastrointestinal side effects also occurred more frequently in the study population when taking the supplement; a good example of how even everyday nutrients come with trade-offs.
There are also some changes but in some inflammatory signaling chemicals called cytokines. Those changes previously have been associates with a more normal response. Here, having vitamin C helps regulate how well the enzymes that activate genes work, as well as how well inflammation is regulated. For those others, who so often are managing insufficient levels of vitamin C, raising those levels might help nudge the natural physiology on a more positive course.
The authors who led this work, including groups from the Van Andel Institute and Copenhagen University Hospital, were cautious in their wording. Survival was not the primary outcome and that was not pre-specified, the trial was modest in size, and the encouraging signal was derived from other analyses, not the primary design. Much larger phase 3 clinical trials will be needed before anyone can confidently claim that daily vitamin C can improve the long-term outlook in such patients. But the findings give us a definitive reason to pursue that next step.
