Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials.
Thorax. 2019 Jan 10. pii: thoraxjnl-2018-212092. doi: 10.1136/thoraxjnl-2018-212092.
Jolliffe DA1, Greenberg L1, Hooper RL1, Mathyssen C2, Rafiq R3, de Jongh RT3, Camargo CA4, Griffiths CJ1,5, Janssens W#2, Martineau AR#1,5.
COPD = Chronic obstructive pulmonary disease , includes chronic bronchitis and emphysema
- Search for COPD in title 45 items as of Jan 2019
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- 100000 IU vitamin D monthly helps COPD patients – 3 RCT
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- COPD ICU stay is 2.4 days longer if low vitamin D – Oct 2015
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- COPD with obstruction: Death 1.7 X more likely with low vitamin D – Sept 2018
COPD and Genes
- COPD strongly associated with Vitamin D receptor problems – meta-analysis Aug 2015
- Gene makes COPD 2.6X more likely unless get more vitamin D – meta-analysis Dec 2014
- COPD 2.6X more likely if poor vitamin D binding protein – meta-analysis Dec 2014
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"Vitamin D Deficiency and Insufficiency in Hospitalized COPD Patients" 2015
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Randomised controlled trials (RCTs) of vitamin D to prevent COPD exacerbations have yielded conflicting results.Individual participant data meta-analysis could identify factors that explain this variation.
PubMed, Embase, the Cochrane Central Register of Controlled Trials and Web of Science were searched from inception up to and including 5 October 2017 to identify RCTs of vitamin D supplementation in patients with COPD that reported incidence of acute exacerbations. Individual participant data meta-analysis was performed using fixed effects models adjusting for age, sex, Global Initiative for Chronic Obstructive Lung Disease spirometric grade and trial.
Four eligible RCTs (total 560 participants) were identified; individual participant data were obtained for 469/472 (99.4%) participants in three RCTs. Supplementation did not influence overall rate of moderate/severe COPD exacerbations (adjusted incidence rate ratio (aIRR) 0.94, 95% CI 0.78 to 1.13). Prespecified subgroup analysis revealed that protective effects were seen in participants with baseline 25-hydroxyvitamin D levels <25 nmol/L (aIRR 0.55, 95% CI 0.36 to 0.84) but not in those with baseline 25-hydroxyvitamin D levels ≥25 nmol/L (aIRR 1.04, 95% CI 0.85 to 1.27; p for interaction=0.015). Vitamin D did not influence the proportion of participants experiencing at least one serious adverse event (adjusted OR 1.16, 95% CI 0.76 to 1.75).
Vitamin D supplementation safely and substantially reduced the rate of moderate/severe COPD exacerbations in patients with baseline 25-hydroxyvitamin D levels <25 nmol/L but not in those with higher levels.
TRIAL REGISTRATION NUMBER: CRD42014013953.