Posted by: Kevin G. Parker, D.C.
Vitamin D as an Early Predictor of Multiple Sclerosis Activity and Progression
Alberto Ascherio, MD, DrPH1; Kassandra L. Munger, ScD1; Rick White, MSc2; Karl Köchert, PhD3; Kelly Claire Simon, ScD1; Chris H. Polman, MD4; Mark S. Freedman, MD5; Hans-Peter Hartung, MD6; David H. Miller, MD7; Xavier Montalbán, MD8; Gilles Edan, MD9; Frederik Barkhof, MD4; Dirk Pleimes, MD10; Ernst-Wilhelm Radü, MD11; Rupert Sandbrink, MD3,6; Ludwig Kappos, MD11; Christoph Pohl, MD3,12
1. Findings suggest that patients in the early stages of MS could stave off disease symptoms by increasing their vitamin D intake.
2. “Because low vitamin D levels are common and can be easily and safely increased by oral supplementation, these findings may contribute to better outcomes for many MS patients,”-lead author Alberto Ascherio, professor of epidemiology and nutrition at HSPH.
3. Researchers found that early stage MS patients who had adequate levels of vitamin D had a 57 percent lower rate of new brain lesions, a 57 percent lower relapse rate, and a 25 percent lower yearly increase in lesion volume than those with lower levels of vitamin D.
4. Loss in brain volume, which is an important predictor of disability, was also lower among patients with adequate vitamin D levels.
5. Researchers also stated the results suggest that vitamin D has a strong protective effect on the disease process underlying MS-and underscore the importance of correcting vitamin D insufficiency.
6. Related article links at bottom of page.
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.
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