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Pretreatment 25-hydroxyvitamin D levels and durability of anti-tumor necrosis factor-α therapy in inflammatory bowel diseases.
JPEN J Parenter Enteral Nutr 2014 Mar-Apr; 38(3):385-91JJ

Abstract

INTRODUCTION

Emerging evidence supports an immunologic role for 25-hydroxyvitamin D (25(OH)D) in inflammatory bowel disease (IBD). Here we examined if pretreatment vitamin D status influences durability of anti-tumor necrosis factor (TNF)-α therapy in patients with Crohn's disease (CD) or ulcerative colitis (UC).

METHODS

All IBD patients who had plasma 25(OH)D level checked <3 months prior to initiating anti-TNF-α therapy were included in this retrospective single-center cohort study. Our main predictor variable was insufficient plasma 25(OH)D (<30 ng/mL). Cox proportional hazards model adjusting for potential confounders was used to identify the independent effect of pretreatment vitamin D on biologic treatment cessation.

RESULTS

Our study included 101 IBD patients (74 CD; median disease duration 9 years). The median index 25(OH)D level was 27 ng/mL (interquartile range, 20-33 ng/mL). One-third of the patients had prior exposure to anti-TNF-α therapy. On multivariate analysis, patients with insufficient vitamin D demonstrated earlier cessation of anti-TNF-α therapy (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.03-4.39; P = .04). This effect was significant in patients who stopped treatment for loss of response (HR, 3.49; 95% CI, 1.34-9.09) and stronger for CD (HR, 2.38; 95% CI, 0.95-5.99) than UC (P = NS).

CONCLUSIONS

Our findings suggest that vitamin D levels may influence durability of anti-TNF-α induction and maintenance therapy. Larger cohort studies and clinical trials of supplemental vitamin D use with disease activity as an end point may be warranted.

Authors+Show Affiliations

Department of Medicine, Massachusetts General Hospital, Boston.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24088707

Citation

Zator, Zachary A., et al. "Pretreatment 25-hydroxyvitamin D Levels and Durability of Anti-tumor Necrosis Factor-α Therapy in Inflammatory Bowel Diseases." JPEN. Journal of Parenteral and Enteral Nutrition, vol. 38, no. 3, 2014, pp. 385-91.
Zator ZA, Cantu SM, Konijeti GG, et al. Pretreatment 25-hydroxyvitamin D levels and durability of anti-tumor necrosis factor-α therapy in inflammatory bowel diseases. JPEN J Parenter Enteral Nutr. 2014;38(3):385-91.
Zator, Z. A., Cantu, S. M., Konijeti, G. G., Nguyen, D. D., Sauk, J., Yajnik, V., & Ananthakrishnan, A. N. (2014). Pretreatment 25-hydroxyvitamin D levels and durability of anti-tumor necrosis factor-α therapy in inflammatory bowel diseases. JPEN. Journal of Parenteral and Enteral Nutrition, 38(3), pp. 385-91. doi:10.1177/0148607113504002.
Zator ZA, et al. Pretreatment 25-hydroxyvitamin D Levels and Durability of Anti-tumor Necrosis Factor-α Therapy in Inflammatory Bowel Diseases. JPEN J Parenter Enteral Nutr. 2014;38(3):385-91. PubMed PMID: 24088707.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pretreatment 25-hydroxyvitamin D levels and durability of anti-tumor necrosis factor-α therapy in inflammatory bowel diseases. AU - Zator,Zachary A, AU - Cantu,Stephanie M, AU - Konijeti,Gauree Gupta, AU - Nguyen,Deanna D, AU - Sauk,Jenny, AU - Yajnik,Vijay, AU - Ananthakrishnan,Ashwin N, Y1 - 2013/10/02/ PY - 2013/10/4/entrez PY - 2013/10/4/pubmed PY - 2014/10/28/medline KW - Crohn’s disease KW - biologic therapy KW - ulcerative colitis KW - vitamin D SP - 385 EP - 91 JF - JPEN. Journal of parenteral and enteral nutrition JO - JPEN J Parenter Enteral Nutr VL - 38 IS - 3 N2 - INTRODUCTION: Emerging evidence supports an immunologic role for 25-hydroxyvitamin D (25(OH)D) in inflammatory bowel disease (IBD). Here we examined if pretreatment vitamin D status influences durability of anti-tumor necrosis factor (TNF)-α therapy in patients with Crohn's disease (CD) or ulcerative colitis (UC). METHODS: All IBD patients who had plasma 25(OH)D level checked <3 months prior to initiating anti-TNF-α therapy were included in this retrospective single-center cohort study. Our main predictor variable was insufficient plasma 25(OH)D (<30 ng/mL). Cox proportional hazards model adjusting for potential confounders was used to identify the independent effect of pretreatment vitamin D on biologic treatment cessation. RESULTS: Our study included 101 IBD patients (74 CD; median disease duration 9 years). The median index 25(OH)D level was 27 ng/mL (interquartile range, 20-33 ng/mL). One-third of the patients had prior exposure to anti-TNF-α therapy. On multivariate analysis, patients with insufficient vitamin D demonstrated earlier cessation of anti-TNF-α therapy (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.03-4.39; P = .04). This effect was significant in patients who stopped treatment for loss of response (HR, 3.49; 95% CI, 1.34-9.09) and stronger for CD (HR, 2.38; 95% CI, 0.95-5.99) than UC (P = NS). CONCLUSIONS: Our findings suggest that vitamin D levels may influence durability of anti-TNF-α induction and maintenance therapy. Larger cohort studies and clinical trials of supplemental vitamin D use with disease activity as an end point may be warranted. SN - 1941-2444 UR - https://www.unboundmedicine.com/medline/citation/24088707/Pretreatment_25_hydroxyvitamin_D_levels_and_durability_of_anti_tumor_necrosis_factor_α_therapy_in_inflammatory_bowel_diseases_ L2 - https://doi.org/10.1177/0148607113504002 DB - PRIME DP - Unbound Medicine ER -