Multiple Sclerosis: 10 percent fewer relapses for each 10 ng higher level of vitamin D – Meta-analysis

Created January 2020

Associations of serum 25(OH) vitamin D levels with clinical and radiological outcomes in multiple sclerosis, a systematic review and meta-analysis

Journal of the Neurological Sciences, Volume 411, 15 April 2020, https://doi.org/10.1016/j.jns.2020.116668

Elena H.Martínez-LapiscinaafRattanapornMahatananbfChih-HongLeecPrangthipCharoenpongdfJia-PeiHongef

1. # The articles in both of the categories MS and Meta-Analysis are: {category} --- 1. Note: >20,000 MS patients on Dr. Coimbra Protocol are being treated by 150 ng of Vitamin D --- {include}

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Highlights

  • Sunlight exposure as a source of Vitamin D has been hypothesized as a protective factor for multiple sclerosis(MS) due to immunomodulatory effects of vitamin D.

  • Our study found

    • each 25 nmol/L increase in serum 25(OH)D levels is associated an average 10% decrease in new relapses and a

    • 14–31% reduction in the risk of new radiological inflammatory activity inpatients with early relapsing MS.

  • Relationship between serum 25(OH)D levels and disability worsening remains inconclusive and deserves further investigation as disability is the main relevant outcome for MS patients.

  • The effects of serum 25(OH)D levels in progressive MS and non-White populations also warrants further investigation.

Background

Vitamin D supplementation is recommended for patients with multiple sclerosis (MS). However, a recent meta-analysis based on low-quality trials suggested no evidence of supplementation benefit. A systematic review and meta-analysis of high-quality observational cohort studies should provide us further evidences.

Methods

MEDLINE, EMBASE, and WEB-of-SCIENCE databases were systematically searched to identify eligible studies published before October 2018. Prospective cohort studies assessing the associations of serum 25(OH)D levels with MS relapses, radiological inflammatory lesions, or changes in expanded disability status scale in adults (≥18 years) with MS were included. Pooled RRs were calculated using fixed-effect or random-effects model depending on heterogeneity.

Results

Thirteen studies and 3498 patients were included. Each 25 nmol/L increase in serum 25(OH)D levels was associated with a reduction in

  • (1) clinical relapse rate [RR = 0.90; 95% confidence interval (CI) = 0.83–0.99],

  • (2) gadolinium-enhancing lesions (RR = 0.69; 95% CI = 0.60–0.79),

  • (3) new/enlarging T2 lesions (RR = 0.86; 95% CI = 0.77–0.95), and

  • (4) new active lesions (RR = 0.81; 95% CI = 0.74–0.89) in the magnetic resonance imaging(MRI).

Conclusions

Serum 25(OH)D levels are associated with a modest decrease in relapse rate and radiological inflammatory activities in patients with MS. The association with disability worsening remains inconclusive.

Tags: Meta-analysis Multiple Sclerosis