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Pretreatment 25-hydroxyvitamin D levels and durability of anti-tumor necrosis factor-α therapy in inflammatory bowel diseases.

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.

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  • Authors+Show Affiliations

    ,

    Department of Medicine, Massachusetts General Hospital, Boston.

    , , , , ,

    Source

    MeSH

    Adolescent
    Adult
    Dietary Supplements
    Female
    Follow-Up Studies
    Humans
    Inflammatory Bowel Diseases
    Male
    Proportional Hazards Models
    Retrospective Studies
    Sensitivity and Specificity
    Tumor Necrosis Factor-alpha
    Vitamin D
    Vitamin D Deficiency
    Young Adult

    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 -