Tuberculosis (multi-drug resistant) was 13.4 X more likely to be quickly cleared with Vitamin D - Meta-analysis

Adjunctive vitamin D in tuberculosis treatment: meta-analysis of individual participant data

European Respiratory Journal 2019; DOI: 10.1183/13993003.02003-2018

David A. Jolliffe, Davaasambuu Ganmaa, Christian Wejse, Rubhana Raqib, Md. Ahsanul Haq, Nawal Salahuddin, Peter K. Daley, Anna P. Ralph, Thomas R. Ziegler, Adrian R. Martineau

* Overview Tuberculosis and Vitamin D 1. # Items in both categories TB and Radomized Controlled Trials are listed here: {category} --- 1. # Items in both categories TB and Meta-analysis are listed here: {category} --- From Press Release 10.0 million people developed active tuberculosis worldwide in 2017, Multi-drug resistant (MDR) TB.occurred in ~500,000 cases. (5%) * "Lead researcher Professor Adrian Martineau from Queen Mary University of London said: "Multi-drug resistant TB is on the rise globally. It's notoriously difficult to treat, and it carries a much worse prognosis than standard TB." * "By adding vitamin D to antibiotic treatment, we can boost the immune system to help the body to clear TB bugs, rather than relying on antibiotics on their own to kill the bacteria directly"

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Vitamin D dosing varied widely: daily, weekly, infrequently, and single

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Background Randomised controlled trials (RCTs) of adjunctive vitamin D in pulmonary tuberculosis (PTB) treatment have yielded conflicting results. Individual participant data (IPD) meta-analysis could identify factors explaining this variation.

Methods We meta-analysed IPD from RCTs of vitamin D in patients receiving antimicrobial therapy for PTB. Primary outcome was time to sputum culture conversion. Secondary outcomes were time to sputum smear conversion, mean 8-week weight and incidence of adverse events. Pre-specified sub-group analyses were done according to baseline vitamin D status, age, sex, drug-susceptibility, HIV status, extent of disease, and vitamin D receptor genotype.

Results IPD were obtained for 1850 participants in 8 studies. Vitamin D did not influence time to sputum culture conversion overall (aHR 1.06, 95% CI 0.91–1.23), but it did accelerate sputum culture conversion in participants with multidrug-resistant PTB ( aHR 13.44 , 95% CI 2.96–60.90); no such effect was seen in those whose isolate was sensitive to rifampicin and/or isoniazid (aHR 1.02, 95% CI 0.88–1.19; Pinteraction=0.02). Vitamin D accelerated sputum smear conversion overall (aHR 1.15, 95% CI 1.01–1.31), but did not influence other secondary outcomes.

Conclusions Vitamin D did not influence time to sputum culture conversion overall, but it accelerated sputum culture conversion in patients with multidrug-resistant PTB.