BACKGROUND: Vitamin D could play a protective role in multiple sclerosis. METHODS: In an observational, uncontrolled study, vitamin D3 supplementation (3010 IU/day on average) was given to 156 consecutive patients with relapsing-remitting multiple sclerosis, under first-line immunomodulatory therapy and with initial 25-OH-D serum level lower than 100 nmol/l (40 ng/ml). Relapses were determined for 29.1 ± 8.4 months during vitamin D and 29.8 ± 10.1 months before supplementation. The 25-OH-D level was measured before supplementation and several times during supplementation. The incidence rate of relapses before and during supplementation was estimated using negative binomial regression models with follow-up durations as offset terms. The incidence rate and incidence rate ratio of relapses at various 25-OH-D levels were also calculated using negative binomial regression models. RESULTS: In 76 patients, immunomodulatory therapy preceded vitamin D supplementation (by 4.2 ± 2.7 years) and in 80 patients both treatments were started simultaneously. Under supplementation, the 25-OH-D level increased from 49 ± 22 nmol/l to 110 ± 26 nmol/l on average. Pooling data collected before and during supplementation, we found a significant strong inverse relationship between the relapse incidence rate and the 25-OH-D level (p < 0.0001), suggesting that vitamin D did indeed influence the relapse rate. Results of univariate, bivariate and multivariate analyses were analogous: in the multivariate model adjusted for age, disease duration and previous use of immunomodulatory therapy, every 10 nmol increase in 25-OH-D level was associated with a reduction in the relapse incidence rate of 13.7%. Dividing iteratively the population made up of pooled periods into two subgroups according to the 25-OH-D levels, the relapse incidence rate ratio decreased as the 25-OH-D level increased up to 110 nmol/l, but a plateau effect was observed beyond this limit. CONCLUSION: Further studies are warranted for accurate quantification of the vitamin D effect.
BACKGROUND:Vitamin D could play a protective role in multiple sclerosis. METHODS: In an observational, uncontrolled study, vitamin D3 supplementation (3010 IU/day on average) was given to 156 consecutive patients with relapsing-remitting multiple sclerosis, under first-line immunomodulatory therapy and with initial 25-OH-D serum level lower than 100 nmol/l (40 ng/ml). Relapses were determined for 29.1 ± 8.4 months during vitamin D and 29.8 ± 10.1 months before supplementation. The 25-OH-D level was measured before supplementation and several times during supplementation. The incidence rate of relapses before and during supplementation was estimated using negative binomial regression models with follow-up durations as offset terms. The incidence rate and incidence rate ratio of relapses at various 25-OH-D levels were also calculated using negative binomial regression models. RESULTS: In 76 patients, immunomodulatory therapy preceded vitamin D supplementation (by 4.2 ± 2.7 years) and in 80 patients both treatments were started simultaneously. Under supplementation, the 25-OH-D level increased from 49 ± 22 nmol/l to 110 ± 26 nmol/l on average. Pooling data collected before and during supplementation, we found a significant strong inverse relationship between the relapse incidence rate and the 25-OH-D level (p < 0.0001), suggesting that vitamin D did indeed influence the relapse rate. Results of univariate, bivariate and multivariate analyses were analogous: in the multivariate model adjusted for age, disease duration and previous use of immunomodulatory therapy, every 10 nmol increase in 25-OH-D level was associated with a reduction in the relapse incidence rate of 13.7%. Dividing iteratively the population made up of pooled periods into two subgroups according to the 25-OH-D levels, the relapse incidence rate ratio decreased as the 25-OH-D level increased up to 110 nmol/l, but a plateau effect was observed beyond this limit. CONCLUSION: Further studies are warranted for accurate quantification of the vitamin D effect.
Entities:
Keywords:
multiple sclerosis; relapse rate; vitamin D; vitamin D supplementation
Authors: Thomas J Wang; Feng Zhang; J Brent Richards; Bryan Kestenbaum; Joyce B van Meurs; Diane Berry; Douglas P Kiel; Elizabeth A Streeten; Claes Ohlsson; Daniel L Koller; Leena Peltonen; Jason D Cooper; Paul F O'Reilly; Denise K Houston; Nicole L Glazer; Liesbeth Vandenput; Munro Peacock; Julia Shi; Fernando Rivadeneira; Mark I McCarthy; Pouta Anneli; Ian H de Boer; Massimo Mangino; Bernet Kato; Deborah J Smyth; Sarah L Booth; Paul F Jacques; Greg L Burke; Mark Goodarzi; Ching-Lung Cheung; Myles Wolf; Kenneth Rice; David Goltzman; Nick Hidiroglou; Martin Ladouceur; Nicholas J Wareham; Lynne J Hocking; Deborah Hart; Nigel K Arden; Cyrus Cooper; Suneil Malik; William D Fraser; Anna-Liisa Hartikainen; Guangju Zhai; Helen M Macdonald; Nita G Forouhi; Ruth J F Loos; David M Reid; Alan Hakim; Elaine Dennison; Yongmei Liu; Chris Power; Helen E Stevens; Laitinen Jaana; Ramachandran S Vasan; Nicole Soranzo; Jörg Bojunga; Bruce M Psaty; Mattias Lorentzon; Tatiana Foroud; Tamara B Harris; Albert Hofman; John-Olov Jansson; Jane A Cauley; Andre G Uitterlinden; Quince Gibson; Marjo-Riitta Järvelin; David Karasik; David S Siscovick; Michael J Econs; Stephen B Kritchevsky; Jose C Florez; John A Todd; Josee Dupuis; Elina Hyppönen; Timothy D Spector Journal: Lancet Date: 2010-06-10 Impact factor: 79.321
Authors: Chris H Polman; Stephen C Reingold; Gilles Edan; Massimo Filippi; Hans-Peter Hartung; Ludwig Kappos; Fred D Lublin; Luanne M Metz; Henry F McFarland; Paul W O'Connor; Magnhild Sandberg-Wollheim; Alan J Thompson; Brian G Weinshenker; Jerry S Wolinsky Journal: Ann Neurol Date: 2005-12 Impact factor: 10.422
Authors: Vanitha A Jagannath; Graziella Filippini; Carlo Di Pietrantonj; G V Asokan; Edward W Robak; Liz Whamond; Sarah A Robinson Journal: Cochrane Database Syst Rev Date: 2018-09-24