Vitamin D accelerates clinical recovery from tuberculosis: results of the SUCCINCT Study [Supplementary Cholecalciferol in recovery from tuberculosis]. A randomized, placebo-controlled, clinical trial of vitamin d supplementation in patients with pulmonary tuberculosis'
BMC Infectious Diseases 2013, 13:22 doi:10.1186/1471-2334-13-22
Nawal Salahuddin, Farheen Ali, Zahra Hasan, Nisar Rao, Masooma Aqeel and Faisal Mahmood
Published: 19 January 2013
Background
Vitamin D enhances host protective immune responses to Mycobacterium tuberculosis by suppressing Interferon-gamma (IFN-g) and reducing disease associated inflammation in the host. The objectives of this study were to determine whether vitamin D supplementation to patients with tuberculosis (TB) could influence recovery.
Methods
Two hundred and fifty nine patients with pulmonary TB were randomized to receive either 600,000 IU of Intramuscular vitamin D3 or placebo for 2 doses. Assessments were performed at 4, 8 and 12 weeks. Early secreted and T cell activated 6 kDa (ESAT6) and Mycobacterium tuberculosis sonicate (MTBs) antigen induced whole blood stimulated IFN-g responses were measured at 0 and 12 weeks. Statistical comparisons between outcome variables at 0 and 12 weeks were performed using Student's t-test and Chi 2 tests.
Results
After 12 weeks, the vitamin D supplemented arm demonstrated significantly
- greater mean weight gain (kg) + 3.75, (3.16 — 4.34)
versus + 2.61 (95% CI 1.99 — 3.23) p 0.009 and - lesser residual disease by chest radiograph;
- number of zones involved 1.35 v/s 1.82 p 0.004 (95% CI 0.15, 0.79) and
- 50% or greater reduction in cavity size 106 (89.8%) v/s 111 (94.8%), p 0.035.
Vitamin D supplementation led to significant increase in MTBs-induced IFN-g secretion in patients with baseline 'Deficient' 25-hydroxyvitamin D serum levels (p 0.021).
Conclusions
Supplementation with high doses of vitamin D accelerated clinical, radiographic improvement in all TB patients and increased host immune activation in patients with baseline 'Deficient' serum vitamin D levels. These results suggest a therapeutic role for vitamin D in the treatment of TB.
Trial registration: ClinicalTrials.gov; No. NCT01130311; URL: clinicaltrials.gov
600,000 IU doses of vitamin D were given on day 0 and again on day 30 (from the PDF)
Reminder: TB sanitoriums, which gave direct sunlight access to TB patients, were found to be very userul a century ago.
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