Abstract
Objective: to examine the extent of effect vitamin D in Multiple Sclerosis (MS) on pathology and symptoms. Methods: A literature search was performed in November 2018 (CRD42018103615). Eligibility criteria: randomised control trials in English from 2012 to 2018; a clinical diagnosis of MS; interventions containing vitamin D supplementation (vitamin D3 or calcitriol) in disease activity compared to a control/placebo; improvement in: serum 25(OH)D, relapse rates, disability status by Expanded Disability Status Scale (EDSS) scores, cytokine profile, quality of life, mobility, T2 lesion load and new T2 or T1 Gd enhancing lesions, safety and adverse effects. Risk of bias was evaluated. Results: Ten studies were selected. The study size ranged from 40 to 94 people. All studies evaluated the use of vitamin D supplementation (ranging from 10 to 98,000 IU), comparing to a placebo or low dose vitamin D. The duration of the intervention ranged from 12 to 96 weeks. One trial found a significant effect on EDSS score, three demonstrated a significant change in serum cytokines level, one found benefits to current enhancing lesions and three studies evaluating the safety and tolerability of vitamin D reported no serious adverse events. Disease measures improved to a greater extent overall in those with lower baseline serum 25(OH)D levels. Conclusions: As shown in 3 out of 10 studies, improvement in disease measures may be more apparent in those with lower baseline vitamin D levels.
Highlights
There is increasing evidence suggesting that specific environmental factors, such as exposure to infectious agents, smoking, poor diet and inadequate levels of vitamin D can influence the disease course of multiple sclerosis (MS) [1]
The aim of this review is to assess the evidence from existing randomised controlled trials for the clinical effectiveness of vitamin D supplementation compared to placebo supplementation in the disease and symptom management of people with MS as measured by: improvement in: serum 25(OH)D, relapse rates, disability status by Expanded Disability Status Scale (EDSS) scores, cytokine profile, quality of life, mobility, T2 lesion load and new T2 or T1 Gd enhancing lesions, safety, and adverse effects
Four of ten studies in this review investigated the effect of supplementation with vitamin D on relapse rates, with no significant differences between the vitamin D and control groups
Summary
There is increasing evidence suggesting that specific environmental factors, such as exposure to infectious agents, smoking, poor diet and inadequate levels of vitamin D can influence the disease course of multiple sclerosis (MS) [1]. Epidemiologic and experimental studies investigating the effectiveness of vitamin D supplementation in MS have shown that low serum vitamin D levels may exacerbate MS symptoms and are associated with higher relapse rates, new lesions, and greater degree of disability [5,6,7,8,9]. The aim of this review is to assess the evidence from existing randomised controlled trials for the clinical effectiveness of vitamin D supplementation compared to placebo supplementation in the disease and symptom management of people with MS as measured by: improvement in: serum 25(OH)D, relapse rates, disability status by Expanded Disability Status Scale (EDSS) scores, cytokine profile, quality of life, mobility, T2 lesion load and new T2 or T1 Gd enhancing lesions, safety, and adverse effects
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