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Vitamin D supplementation reduces relapse rate in relapsing-remitting multiple sclerosis patients treated with natalizumab

Multiple Sclerosis and Related Disorders, November 2016, Pages 169 - 173

Abstract

Background

Vitamin D insufficiency is common among multiple sclerosis patients, and hypovitaminosis D has been associated with multiple sclerosis (MS) risk and disease activity.

Objective

To investigate how recommendations on vitamin D3 supplements affect 25-hydroxyvitamin D (25(OH)D) levels in patients with relapsing-remitting MS (RRMS) and to examine the clinical effects associated with changes in 25(OH)D levels.

Methods

In this prospective cohort study, baseline blood samples were collected from 170 natalizumab-treated RRMS patients during winter 2009–2010 and were repeated the following winter. Vitamin D supplements were recommended according to standard clinical practice in our clinic to patients with serum 25(OH)D<50 nmol/l at baseline. Information was obtained on annualized relapse-rate (ARR) the year prior to baseline and the following year.

Results

We found that recommending vitamin D supplements in patients with vitamin D insufficiency was associated with a significant increase in serum 25(OH)D concentrations (p=5.1×10−10), which was significantly related with decreases in ARR; for each nmol/l increase in Δ25(OH)D a −0.014 (95% CI −0.026 to −0.003) decrease in ΔARR was observed, p=0.02.

Conclusion

Correction of hypovitaminosis D in clinical practice by recommending oral D3 supplements resulted in increases in 25(OH)D levels in serum, which were associated with decreases in ARR in RRMS.

Highlights

  • Recommending vitamin D3 supplements in vitamin D insufficient, relapsing-remitting MS patients is associated with increased 25-hydroxyvitamin D (25(OH)D) levels.
  • Increased 25(OH)D levels in these patients are associated with decreases in the annualized relapse rate (ARR).
  • No association was found between changes in 25(OH)D and changes in gene expression of molecules representing the immune system. This reflects how complex vitamin D research is.

Keywords: Multiple sclerosis, 25-hydroxyvitamin D, Vitamin D3 supplement, Annualized relapse-rate, Immunomodulation.

Footnotes

Rigshospitalet, Copenhagen University Hospital, Danish Multiple Sclerosis Center, Department of Neurology, Blegdamsvej 9, 2100 Copenhagen, Denmark

Corresponding author.