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Vitamin D as an early predictor of multiple sclerosis activity and progression.

Abstract

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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  • Authors+Show Affiliations

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    Harvard School of Public Health, Boston, Massachusetts.

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    Harvard School of Public Health, Boston, Massachusetts.

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    University of British Columbia, Vancouver, Canada.

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    Bayer HealthCare, Berlin, Germany.

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    Harvard School of Public Health, Boston, Massachusetts.

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    VU University Medical Center, Amsterdam, the Netherlands.

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    Ottawa Hospital Research Institute, Ottawa, Canada.

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    Heinrich-Heine Universität, Düsseldorf, Germany.

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    University College London Institute of Neurology, London, England.

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    Hospital Universitari Vall d'Hebron, Barcelona, Spain.

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    CHU-Hôpital Pontchaillou, Rennes, France.

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    VU University Medical Center, Amsterdam, the Netherlands.

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    Bayer HealthCare Pharmaceuticals, Montville, New Jersey.

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    University Hospital Basel, Basel, Switzerland.

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    Bayer HealthCare, Berlin, Germany6Heinrich-Heine Universität, Düsseldorf, Germany.

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    University Hospital Basel, Basel, Switzerland.

    Bayer HealthCare, Berlin, Germany12Department of Neurology, University Hospital of Bonn, Bonn, Germany.

    Source

    JAMA neurology 71:3 2014 Mar pg 306-14

    MeSH

    Adult
    Biomarkers
    Demyelinating Diseases
    Disease Progression
    Female
    Follow-Up Studies
    Humans
    Magnetic Resonance Imaging
    Male
    Multiple Sclerosis
    Predictive Value of Tests
    Randomized Controlled Trials as Topic
    Recurrence
    Risk Factors
    Time Factors
    Vitamin D

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    24445558

    Citation

    Ascherio, Alberto, et al. "Vitamin D as an Early Predictor of Multiple Sclerosis Activity and Progression." JAMA Neurology, vol. 71, no. 3, 2014, pp. 306-14.
    Ascherio A, Munger KL, White R, et al. Vitamin D as an early predictor of multiple sclerosis activity and progression. JAMA Neurol. 2014;71(3):306-14.
    Ascherio, A., Munger, K. L., White, R., Köchert, K., Simon, K. C., Polman, C. H., ... Pohl, C. (2014). Vitamin D as an early predictor of multiple sclerosis activity and progression. JAMA Neurology, 71(3), pp. 306-14. doi:10.1001/jamaneurol.2013.5993.
    Ascherio A, et al. Vitamin D as an Early Predictor of Multiple Sclerosis Activity and Progression. JAMA Neurol. 2014;71(3):306-14. PubMed PMID: 24445558.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Vitamin D as an early predictor of multiple sclerosis activity and progression. AU - Ascherio,Alberto, AU - Munger,Kassandra L, AU - White,Rick, AU - Köchert,Karl, AU - Simon,Kelly Claire, AU - Polman,Chris H, AU - Freedman,Mark S, AU - Hartung,Hans-Peter, AU - Miller,David H, AU - Montalbán,Xavier, AU - Edan,Gilles, AU - Barkhof,Frederik, AU - Pleimes,Dirk, AU - Radü,Ernst-Wilhelm, AU - Sandbrink,Rupert, AU - Kappos,Ludwig, AU - Pohl,Christoph, PY - 2014/1/22/entrez PY - 2014/1/22/pubmed PY - 2014/5/16/medline SP - 306 EP - 14 JF - JAMA neurology JO - JAMA Neurol VL - 71 IS - 3 N2 - 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. SN - 2168-6157 UR - https://www.unboundmedicine.com/medline/citation/24445558/full_citation L2 - https://jamanetwork.com/journals/jamaneurology/fullarticle/10.1001/jamaneurol.2013.5993 DB - PRIME DP - Unbound Medicine ER -