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Multiple Sclerosis progressed more slowly if have 20 ng more vitamin D – Jan 2014

Vitamin D as an Early Predictor of Multiple Sclerosis Activity and Progression

JAMA Neurol. 2014 Jan 20. doi: 10.1001/jamaneurol.2013.5993.
Ascherio A1, Munger KL1, White R2, Köchert K3, Simon KC1, Polman CH4, Freedman MS5, Hartung HP6, Miller DH7, Montalbán X8, Edan G9, Barkhof F4, Pleimes D10, Radü EW11, Sandbrink R12, Kappos L11, Pohl C13.
1Harvard School of Public Health, Boston, Massachusetts.
2University of British Columbia, Vancouver, Canada.
3Bayer HealthCare, Berlin, Germany.
4VU University Medical Center, Amsterdam, the Netherlands.
5Ottawa Hospital Research Institute, Ottawa, Canada.
6Heinrich-Heine Universität, Düsseldorf, Germany.
7University College London Institute of Neurology, London, England.
8Hospital Universitari Vall d'Hebron, Barcelona, Spain.
9CHU-Hôpital Pontchaillou, Rennes, France.
10Bayer HealthCare Pharmaceuticals, Montville, New Jersey.
11University Hospital Basel, Basel, Switzerland.
12Bayer HealthCare, Berlin, Germany 6Heinrich-Heine Universität, Düsseldorf, Germany.
13Bayer HealthCare, Berlin, Germany 12Department of Neurology, University Hospital of Bonn, Bonn, Germany

IMPORTANCE It remains unclear whether vitamin D insufficiency, which is common in individuals with multiple sclerosis (MS), has an adverse effect on MS outcomes.

OBJECTIVES To determine whether serum concentrations of 25-hydroxyvitamin D (25[OH]D), a marker of vitamin D status, predict disease activity and prognosis in patients with a first event suggestive of MS (clinically isolated syndrome).

DESIGN, SETTING, AND PARTICIPANTS The Betaferon/Betaseron in Newly Emerging multiple sclerosis For Initial Treatment study was a randomized trial originally designed to evaluate the impact of early vs delayed interferon beta-1b treatment in patients with clinically isolated syndrome. Serum 25(OH)D concentrations were measured at baseline and 6, 12, and 24 months. A total of 465 of the 468 patients randomized had at least 1 25(OH)D measurement, and 334 patients had them at both the 6- and 12-month (seasonally asynchronous) measurements. Patients were followed up for 5 years clinically and by magnetic resonance imaging.

MAIN OUTCOMES AND MEASURES New active lesions, increased T2 lesion volume, and brain volume on magnetic resonance imaging, as well as MS relapses and disability (Expanded Disability Status Scale score).

RESULTS Higher 25(OH)D levels predicted reduced MS activity and a slower rate of progression.
A 50-nmol/L (20-ng/mL) increment in average serum 25(OH)D levels within the first 12 months predicted a

  • 57% lower rate of new active lesions (P < .001),
  • 57% lower relapse rate (P = .03), 25% lower yearly increase in T2 lesion volume (P < .001), and
  • 0.41% lower yearly loss in brain volume (P = .07) from months 12 to 60.

Similar associations were found between 25(OH)D measured up to 12 months and MS activity or progression from months 24 to 60. In analyses using dichotomous 25(OH)D levels, values greater than or equal to 50 nmol/L (20 ng/mL) at up to 12 months predicted lower disability (Expanded Disability Status Scale score, -0.17; P = .004) during the subsequent 4 years.

CONCLUSIONS AND RELEVANCE Among patients with MS mainly treated with interferon beta-1b, low 25(OH)D levels early in the disease course are a strong risk factor for long-term MS activity and progression.

PMID: 24445558

For years Dr.s in Brazil have added 120 ng of vitamin D (150 ng total) to achieve reversal of Multiple Sclerosis.

See also VitaminDWiki

Clinical interventions have shown that Vitamin D can prevent, treat, and even cure Multiple Sclerosis, at a tiny fraction of the cost of the drugs now used to treat it, and without side effects.

Summary: lack of consensus on how much to prevent, treat, or cure MS.

MS updates from Brazil

Comments by Doctors on this study

From Gupta: Friday Feedback: Vitamin D — the MS Magic Bullet?

Published: Jan 24, 2014
This week, Friday Feedback takes a second look at a reported correlation between vitamin D and slower disease progression in multiple sclerosis patients.

We reached out to a diverse group of physicians by email and asked them to respond to the following question:

On the strength of these observational data, how would you use these findings in the clinical management of your MS patients?

The participants this week:

  • Cherie C. Binns, RN, an independent multiple sclerosis-certified nurse based in Wakefield, R.I.
  • Marian L. Evatt, MD, MS, Department of Neurology, Emory University School of Medicine
  • Robert Fox, MD, an MS specialist in the Mellen Center for Multiple Sclerosis at the Cleveland Clinic
  • J. William Lindsey, MD, professor of neurology at the University of Texas Health Science Center at Houston (UTHealth) Medical School and a member of the Mischer Neuroscience Institute at Memorial Hermann-Texas Medical Center
  • Eva-Maria Maida, MD, professor and chair, department of neurology, Evangelical Hospital Vienna, Austria
  • Anthony T. Reder, MD, professor of neurology with a focus in multiple sclerosis, The Committees on Neurobiology and Immunology, University of Chicago Medicine

Study Adds to the Evidence
Marian L. Evatt, MD, MS: "This doesn't surprise me - - because of available data on MS and bone health, I've been trying to keep MS (and other neurology) patients >30 ng/mL for a while. So this study won't change what I do for MS patients. That said, I don't know how well these kinds of findings have gotten out to the general practice community, so this adds to the body of evidence to support general neurologists and primary care physicians paying attention to vitamin D levels in patients with newly diagnosed MS. Compared with many of my neurology colleagues, I am relatively aggressive about keeping 25OH vitamin D levels replete because there's plenty of evidence vitamin D interventions work for bone health and fall prevention (issues MS and other neurology patients commonly have)."

Eva-Maria Maida, MD: "I have been measuring the blood level of vitamin D in MS patients for several years. Nearly no one shows a normal level in Austria. I find this data very interesting. The methods of evaluating and looking for the correlation of vitamin D to MS progression, especially in the early stage of the disease, are convincing."

Robert Fox, MD: "There is a growing collection of data indicating that vitamin D deficiency is associated with poor outcomes in patients with MS. This study adds to that dataset and suggests that vitamin D supplementation may be beneficial in MS, even in patients already taking a standard MS therapy. Perhaps just as importantly, this study confirms previous observations that higher levels of vitamin D beyond normal levels do not confer further benefit. Vitamin D supplementation is not a "more is better" issue, but rather a "correct the deficiency" issue."

Cherie C. Binns, RN: "Many of the neurologists with whom I communicate are now trying to dose supplemental D3 to elevate serum levels to 80 or greater in their patients with MS. However, it's the People with Multiple Sclerosis (PWMS) who seem to be taking this far more seriously than their healthcare team and many admit to taking megadoses (100,000 IU or more weekly)."

J. William Lindsey, MD: "These observations agree with multiple previous studies reporting that low vitamin D levels are associated with more disease activity."

Anthony T. Reder, MD: "It is a correlation, but that is still important."

Case Closed?
Reder: "An alternative explanation for these findings could be healthy people play outside and have higher vitamin D from more sunshine.
My recommendation to patients is take 4000 U per day in the winter, or take a winter vacation in a sunny place."

Binns: "Unfortunately, the FDA continues to maintain its low Recommended Daily Allowances (RDA) for D and there do not seem to be clear guidelines as to maximum dose of benefit or dose, when exceeded, that may be problematic. There is far too little information available as to signs of D toxicity or overdose. Please address this topic this year."

Evatt: "Presence and or worsening of several neurologic diseases have recently been associated with low vitamin D levels; the trouble is we don't know if the disease causes the low D or low D contributes to the disease/disease worsening. Evidence is strong that optimal bone health levels should be above 30, but we can't say whether it's better to get vitamin D levels higher ... e.g., above 40 or 60 or 70."

Lindsey: "The outstanding remaining question is whether treatment to increase vitamin D levels will have a clinical benefit in MS.
The results from a few small studies of vitamin D supplementation in MS are contradictory.
At present, it is reasonable to measure vitamin D levels in MS patients, and give supplements to those with low vitamin D."

Fox: "Confirmation that vitamin D supplementation is indeed helpful in MS still awaits a formal clinical trial."

Attached files

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