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- Title
The Case for Vitamin D Supplementation in Relapsing-Remitting Multiple Sclerosis (RRMS).
- Authors
Ganesh, Aravind; Pandya, Rup; Patten, Scott
- Abstract
Background: Given that vitamin D has a role in immunomodulation, and its levels appear to correlate with the development of Multiple Sclerosis (MS), it is conceivable that vitamin D may also influence disease activity in MS patients. In this regard, we conducted a systematic review investigating the evidence for the role of vitamin D in disease activity in MS, in the context of the Bradford-Hill criteria of causation, and for the therapeutic supplementation of vitamin D in Relapsing-Remitting MS (RRMS). Methods: A Medline search combining the MeSH terms 'Multiple Sclerosis' with 'Vitamin D' or 'Vitamin D Deficiency' yielded 146 results. These were then limited by clinical trials, giving 7 articles suitable for appraisal, the bibliographies of which were searched, giving one additional article for review. Results/Interpretation: Overall, the current literature suggests that vitamin D plays an important role in disease activity in MS, with both cross-sectional and longitudinal studies demonstrating a strong positive correlation between vitamin D deficiency and the incidence of relapse and/or disability in patients with RRMS. As well, there appears to be a negative correlation between vitamin D levels and inflammatory markers in MS patients, suggesting that vitamin D modifies serum cytokines to a more anti-inflammatory profile, thus providing a plausible model for vitamin D immunomodulation in MS. However, as the Bradford-Hill criteria of temporality, dose-response, and reversibility are yet to be met, the current evidence does not permit inference of a causal relationship between vitamin D deficiency and disease activity in RRMS. As for therapeutic supplementation, high-dose vitamin D supplementation (>10,000 IU/day) appears to be safe and well tolerated by RRMS patients, with preliminary evidence suggesting that this can help them remain relapse free. We calculated the number of patients that would need to be treated (NNT) to prevent one patient from relapsing over a year, giving a remarkably small NNT (unweighted) of 3.37, making vitamin D supplementation a promising new treatment option for MS patients that is worthy of further exploration. Nonetheless, owing to the paucity of longitudinal, placebo-controlled studies on the subject, the evidence for vitamin D supplementation in MS is not definitive.
- Subjects
VITAMIN D; MULTIPLE sclerosis; IMMUNOREGULATION; VITAMIN D deficiency; VITAMIN therapy
- Publication
UBC Medical Journal, 2011, Vol 2, Issue 2, p11
- ISSN
1920-7425
- Publication type
Abstract