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MS relapse rate reduced 14 percent for each 4 ng increase in vitamin D – May 2012

Relationship between 25-OH-D serum level and relapse rate in multiple sclerosis patients

before and after vitamin D supplementation

Therapeutic Advances in Neurological Disorders May 17, 2012 1756285612447090
Charles Pierrot-Deseilligny cp.deseilligny at psl.aphp.fr
Service de Neurologie 1, Hôpital de la Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie (Paris VI), Paris, France
Sophie Rivaud-Péchoux: INSERM URMS 975, CNRS 7225, Université Pierre et Marie Curie (Paris VI), Paris, France
Pierre Clerson: Orgamétrie biostatistiques, Roubaix, France
Raphaël de Paz: Service de Neurologie 1, Hôpital de la Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie (Paris VI), Paris, France
Jean-Claude Souberbielle: Service d’explorations fonctionnelles, Hôpital Necker-Enfants-Malades, Assist. Publique- Hôpitaux de Paris, Université René Descartes (Paris V), Paris, France

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, every10 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.

PDF is attached at the bottom of this page

Figure 2. Relapse incidence rate according to 25-OH-D serum level.

Image
X-axis: quintile of 25-OH-D serum levels;
Y-axis: incidence rate. Q1 to q5 are quintiles of 25-OH-D serum levels, numbers are relapse incidence rate:
q1 : ?55.5 nmol/l; q2: >55.5 to ?78.5 nmol/l; q3: >78.5 to ?97.25 nmol/l; q4: >97.25 to ?121.5 nmol/l; q5: >121.5 nmol/l.
In black, whole population;
in blue, Group 1 (IMT started prior to vitamin D supplementation);
in red, Group 2 (IMT started concomitantly with vitamin D supplementation).
– – – – – – – –

Summary

  • 3100 IU reduced MS relapse rate
  • Each 4 nanogram increase in vitamin D level reduced relapse rate by 13.7 %
  • Started at 20 nanograms, Plateau at 44 nanograms
  • Chart appear to show that having IMT before Vitamin D hinders the amount of vitamin D increase

See also VitaminDWiki

See also web

  • Evidence mounts for vitamin D multiple sclerosis role News Medical June 2012
    doubling of vitamin D levels was associated with a 27% reduction in MS relapse risk.- Netherlands
    10% reduction in rate of relapse for each 4 ng increase in vitamin D levels - Australia
  • Vitamin D Council comment on the paper
    Overall, they saw a 75% reduction in relapse rates if patients achieved a vitamin D level greater than 120 nmol/L (48 ng/ml).
    Conclusion by author: “While awaiting the results of randomized controlled trials, which will not be available for several years, it appears wise to supplement all MS patients currently in a state of vitamin D insufficiency in order to bring their vitamin D levels to just over the 100 nmol/L (40 ng/ml) level, since such supplementation already seems unavoidable from a general medical view, is safe, and might also be neurologically beneficial for the course of the disease.”

Attached files

ID Name Comment Uploaded Size Downloads
1502 MS Relapse rate.jpg admin 01 Aug, 2012 15:25 13.18 Kb 899
1501 MS relapse.pdf PDF admin 01 Aug, 2012 15:16 915.36 Kb 697
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