Taking high-dose vitamin D daily over the long term helps reduce MS relapses
Review shows supplementation past 1 year can also improve disability scores
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Research shows that adding long-term, high-dose vitamin D to standard MS therapies can cut relapse risk and ease disability. (Photo from iStock)
- Long-term, high-dose vitamin D supplementation reduces MS relapses and disability progression.
- This benefit occurs when vitamin D is added to standard MS therapies for more than one year.
- Low vitamin D levels are associated with increased MS risk and faster disease progression.
Taking high-dose vitamin D supplements for more than a year can significantly cut relapse risks and ease disability for people with multiple sclerosis (MS), according to a comprehensive review of more than 30 clinical trials.
These benefits were observed in patients who added the vitamin to their standard disease-modifying therapies, though the supplements had to be taken long term to be effective. Long-term supplementation with a mid-dose also led to fewer relapses, the data showed. In contrast, add-on high-dose vitamin D taken for less than one year showed no significant differences.
“Vitamin D supplementation as an adjuvant therapy may reduce relapse and disability progression, with a favorable safety profile,” researchers wrote in the study “Vitamin D for multiple sclerosis as an adjuvant therapy: A network meta-analysis of randomized controlled trials,” which was published in Clinical Nutrition.
MS is characterized by inflammatory attacks that damage the brain and spinal cord, and it’s well established that vitamin D can influence disease onset and progression. Studies have found an association between low vitamin D blood levels and a higher risk of developing MS, while other research suggests that people with lower vitamin D levels experience more frequent relapses and faster disability progression.
As a result, both the American Academy of Neurology and the European Academy of Neurology have incorporated vitamin D as an adjuvant therapy in their MS treatment guidelines.
The need for specific dosing guidelines
However, those guidelines address vitamin D supplementation only in broad terms and do not provide specific recommendations on appropriate doses or treatment duration. This has limited the practical application of vitamin D in clinical settings, according to the researchers.
To address this, researchers in China pooled the results of published clinical trials to provide more detailed, evidence-based guidance on the optimal vitamin D regimen for MS patients.
“This approach enables a deeper understanding of the role of vitamin D and offers evidence-based guidance for vitamin D therapy in MS patients to support clinical decision-making,” the team wrote.
The analysis focused on 32 clinical trials in which patients were randomly assigned to various doses of vitamin D or a placebo. These trials involved a total of 2,254 MS patients and, except for five that did not have any specific requirements on MS therapies, all others tested vitamin D as an add-on to standard disease-modifying therapies.
Pooled data from all studies showed that vitamin D supplementation for more than one year was associated with a 20% reduction in relapse risk and a modest but significant improvement in disability scores (indicating less severe symptoms) compared with a placebo.
Long-term vitamin D supplementation was also associated with a 49% lower risk of having lesions with active inflammation and a significant reduction in total lesion volume. Relapse rates, however, were not significantly different between the groups.
Vitamin D supplementation over the short term did not significantly affect relapse risk, disability levels, or relapse rates.
The team then compared different dosing and duration strategies. Interventions were classified by dose: low (less than 1,000 international units, or IU, per day), medium or mid-dose (1,000 to 4,000 IU/day), and high (more than 4,000 IU/day). They were also classified by duration: short (one year or less) or long (more than one year).
For outcomes measured beyond one year of follow-up, high-dose, long-duration supplementation showed the greatest benefit for both disability scores and relapse risk. Mid-dose, long-duration supplementation showed the most favorable results for relapse rates.
In terms of safety, vitamin D supplementation did not increase the risk of serious adverse events, which included outcomes such as death, hospitalization, pregnancy complications, and kidney stones.
The certainty of the evidence, assessed using the GRADE framework, was rated as low for short-term outcomes and moderate for long-term outcomes in relapses and disability levels. For the analysis comparing different dosing strategies, specifically, the certainty of evidence was rated as very low across all interventions.
“Further large-scale [randomized controlled trials] are required to validate the efficacy and safety of different vitamin D dosing regimens and explore personalized therapeutic approaches based on biomarkers,” the researchers concluded.
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