Vitamin D as an early predictor of multiple sclerosis activity and progression - PubMed (original) (raw)

doi: 10.1001/jamaneurol.2013.5993.

Kassandra L Munger 1, Rick White 2, Karl Köchert 3, Kelly Claire Simon 1, Chris H Polman 4, Mark S Freedman 5, Hans-Peter Hartung 6, David H Miller 7, Xavier Montalbán 8, Gilles Edan 9, Frederik Barkhof 4, Dirk Pleimes 10, Ernst-Wilhelm Radü 11, Rupert Sandbrink 12, Ludwig Kappos 11, Christoph Pohl 13

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

Alberto Ascherio et al. JAMA Neurol. 2014 Mar.

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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Figures

Figure 1

Figure 1

MS outcomes according to dichotomous serum 25(OH)D levels. A: Probability of conversion to CDMS after 12 months; B) Cumulative number of new active lesions on brain MRI; C: % change in T2 lesion volume from year 1 to year 5 on brain MRI; D: % change in brain volume from year 1 to year 5.

Figure 1

Figure 1

MS outcomes according to dichotomous serum 25(OH)D levels. A: Probability of conversion to CDMS after 12 months; B) Cumulative number of new active lesions on brain MRI; C: % change in T2 lesion volume from year 1 to year 5 on brain MRI; D: % change in brain volume from year 1 to year 5.

Figure 1

Figure 1

MS outcomes according to dichotomous serum 25(OH)D levels. A: Probability of conversion to CDMS after 12 months; B) Cumulative number of new active lesions on brain MRI; C: % change in T2 lesion volume from year 1 to year 5 on brain MRI; D: % change in brain volume from year 1 to year 5.

Figure 1

Figure 1

MS outcomes according to dichotomous serum 25(OH)D levels. A: Probability of conversion to CDMS after 12 months; B) Cumulative number of new active lesions on brain MRI; C: % change in T2 lesion volume from year 1 to year 5 on brain MRI; D: % change in brain volume from year 1 to year 5.

Figure 2

Figure 2

MRI evidence of MS activity (panels A and B) and progression (panel C). A: Rate ratio of new active lesions on brain MRI up to year 5. B: Change of T2 lesion volume on brain MRI from year 1 to year 5 by quintiles of serum 25(OH)D. C: Annualized change in EDSS from 6 months to year 5 by quintiles of serum 25(OH)D.

Figure 2

Figure 2

MRI evidence of MS activity (panels A and B) and progression (panel C). A: Rate ratio of new active lesions on brain MRI up to year 5. B: Change of T2 lesion volume on brain MRI from year 1 to year 5 by quintiles of serum 25(OH)D. C: Annualized change in EDSS from 6 months to year 5 by quintiles of serum 25(OH)D.

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