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@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.

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).

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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

• Overview MS and vitamin D

• Vitamin D reduces multiple sclerosis relapses, but not with interferon treatment – June 2012

• All items in category MS and vitamin D 125 items as of May 2012

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.”