Should we be prescribing vD supplements to all of our patients with MS? #ResearchSpeak #MSBlog
"The study below shows no correlation with low baseline vD levels and future disability progression. However, it did show a correlation with relapses in young pwMS. I am not surprised by this data as it is becoming increasingly clear in established MS that low levels of vD levels may be due to reverse causation, i.e. inflammatory disease activity lowers vD levels rather than the low vD levels driving inflammatory disease activity. The latter is called the consumptive vD hypothesis. Please note this interpretation does not apply to disease susceptibility, i.e. low vD levels are an important risk factor for developing MS. To test the latter hypothesis we need to population-based prevention studies."
"You may ask, based on my interpretation of this data, why do we recommend vD supplementation to people with an established diagnosis of MS? We do this as part of our holistic approach to the management of MS and do it for bone and general health. I tell my patients that based on the current evidence we can't support the use of vD as a DMT in MS. There are ongoing trials addressing this question; we will need to wait to see the results."
BACKGROUND AND OBJECTIVE: The risk of developing multiple sclerosis (MS) as well as MS disease activity is associated with vitamin D (25(OH)D) status. The relationship between the main functional disability hallmark of MS, disability progression, and 25(OH)D status is less well established though, especially not in MS patients with progressive disease.
METHODS: This retrospective follow-up study included 554 MS patients with a serum baseline 25(OH)D level and Expanded Disability Status Scale (EDSS) with a minimum follow-up of three years. Logistic regressions were performed to assess the effect of baseline 25(OH)D status on relapse rate. Repeated measures linear regression analyses were performed to assess the effect on disability and disability progression.
RESULTS: Baseline deseasonalized 25(OH)D status was associated with subsequent relapse risk (yes/no), but only in the younger MS patients (≤ 37.5 years; OR = 0.872, per 10 nmol/L 25(OH)D, p = 0.041). Baseline 25(OH)D status was not significantly associated with either disability or disability progression, irrespective of MS phenotype.
CONCLUSION: Within the physiological range, 25(OH)D status is just significantly associated with the occurrence of relapses in younger MS patients, but is not associated with disability or disability progression over three years follow-up. Whether high dose supplementation to supra physiological 25(OH)D levels prevents disability progression in MS should become clear from long term follow-up of supplementation studies.