Inflammatory activity and vitamin D levels in an MS population treated with rituximab

Background Most multiple sclerosis patients on disease-modifying treatment at Umeå University Hospital are treated with rituximab and the prevalence of vitamin D supplementation has increased over time. Follow-up studies of these off-label treatments are needed. Objective To study inflammatory activity and adverse effects in rituximab-treated multiple sclerosis patients, and associations with 25-hydroxy-vitamin D levels. Methods Retrospectively collected data on repeated estimates of relapses, disability, side effects, magnetic resonance imaging, laboratory measures including 25-hydroxy-vitamin D levels and self-perceived health. Results In 272 multiple sclerosis patients with a mean follow-up of 43 months, we identified seven possible relapses during active rituximab treatment. On magnetic resonance imaging examination, new T2 lesions were seen in 1.3% (10 out of 792 scans), and 0.25% (two out of 785 scans) showed contrast enhancement. Adjusted 25-hydroxy-vitamin D levels in samples drawn close to all magnetic resonance images with new T2 lesions were lower compared to the remainder (62 vs. 81 nmol/l; P = 0.030). Levels of 25-hydroxy-vitamin D were associated with self-perceived health ( r = 0.18, P = 0.041, n = 130) and C-reactive protein ( r = –0.13, P = 0.042) but not with the risk of side effects. Conclusion The inflammatory activity in this rituximab-treated multiple sclerosis population that increasingly used vitamin D supplementation was extremely low. Higher 25-hydroxy-vitamin D levels were associated with beneficial outcomes.

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Comparison of Antioxidant Status and Vitamin D Levels between Multiple Sclerosis Patients and Healthy Matched Subjects

Multiple Sclerosis International ◽

10.1155/2014/539854 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Ehsan Hejazi ◽

Reza Amani ◽

Naser SharafodinZadeh ◽

Bahman Cheraghian

Keyword(s):

Multiple Sclerosis ◽

Vitamin D ◽

Dietary Intake ◽

Antioxidant Status ◽

Sun Exposure ◽

Total Antioxidant Status ◽

Serum Levels ◽

Study Groups ◽

Vitamin D Levels ◽

Multiple Sclerosis Patients

Objective. The aim of the present study was to compare the serum levels of total antioxidant status (TAS) and 25(OH) D3 and dietary intake of multiple sclerosis (MS) patients with those of normal subjects.Method. Thirty-seven MS patients (31 women) and the same number of healthy matched controls were compared for their serum levels and dietary intake of 25(OH) D3 and TAS. Sun exposure and the intake of antioxidants and vitamin D rich foods were estimated through face-to-face interview and food frequency questionnaire.Results. Dietary intake of antioxidants and vitamin D rich foods, vitamin C, vitamin A, and folate was not significantly different between the two groups. There were also no significant differences in the mean levels of 25(OH) D3 and TAS between the study groups. Both groups had low serum levels of 25(OH) D3 and total antioxidants.Conclusion. No significant differences were detected in serum levels and dietary intake of vitamin D and antioxidants between MS patients and healthy controls. All subjects had low antioxidant status and vitamin D levels.

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Vitamin D supplementation in multiple sclerosis patients in 2012: hype or reality as an adjunctive therapy?

Acta Neurologica Belgica ◽

10.1007/s13760-012-0162-6 ◽

2012 ◽

Vol 112 (4) ◽

pp. 325-325

Author(s):

V. van Pesch ◽

C. J. M. Sindic

Keyword(s):

Multiple Sclerosis ◽

Vitamin D ◽

Adjunctive Therapy ◽

Vitamin D Supplementation ◽

Multiple Sclerosis Patients

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Reducing return of disease activity in patients with relapsing multiple sclerosis transitioned from natalizumab to teriflunomide: 12-month interim results of teriflunomide therapy

Multiple Sclerosis Journal - Experimental Translational and Clinical ◽

10.1177/2055217318824618 ◽

2019 ◽

Vol 5 (1) ◽

pp. 205521731882461

Author(s):

Stanley L Cohan ◽

Keith Edwards ◽

Lindsay Lucas ◽

Tiffany Gervasi-Follmar ◽

Judy O’Connor ◽

...

Keyword(s):

Multiple Sclerosis ◽

Disease Activity ◽

Brain Magnetic Resonance Imaging ◽

T2 Lesions ◽

Disability Status ◽

The Mean ◽

Multiple Sclerosis Patients ◽

Mean Time ◽

Relapsing Multiple Sclerosis

Background Natalizumab is an effective treatment for relapsing multiple sclerosis. Return of disease activity upon natalizumab discontinuance creates the need for follow-up therapeutic strategies. Objective To assess the efficacy of teriflunomide following natalizumab discontinuance in relapsing multiple sclerosis patients. Methods Clinically stable relapsing multiple sclerosis patients completing 12 or more consecutive months of natalizumab, testing positive for anti-John Cunningham virus antibody, started teriflunomide 14 mg/day, 28 ± 7 days after their final natalizumab infusion. Physical examination, Expanded Disability Status Scale, laboratory assessments, and brain magnetic resonance imaging were performed at screening and multiple follow-up visits. Results Fifty-five patients were enrolled in the study. The proportion of patients relapse-free was 0.94, restricted mean time to first gadolinium-enhancing lesion was 10.9 months and time to 3-month sustained disability worsening was 11.8 months. The mean number of new or enlarging T2 lesions per patient at 12 months was 0.42. Exploratory analyses revealed an annualized relapse rate of 0.08, and a proportion of patients with no evidence of disease activity of 0.68. Forty-seven patients (85.5%) reported adverse events, 95% of which were mild to moderate. Conclusions Teriflunomide therapy initiated without natalizumab washout resulted in a low rate of return of disease activity. Clinicians may consider this a worthwhile strategy when transitioning clinically stable patients off natalizumab to another therapy. ClinicalTrials.gov Identifier: NCT01970410

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KLOTO rs1207588 allelic variant affects serum vitamin D levels in multiple sclerosis patients

Clinica Chimica Acta ◽

10.1016/j.cca.2019.03.1286 ◽

2019 ◽

Vol 493 ◽

pp. S614

Author(s):

L. Agnello ◽

C. Scazzone ◽

B. Lo Sasso ◽

G. Bivona ◽

G. Iacolino ◽

...

Keyword(s):

Multiple Sclerosis ◽

Vitamin D ◽

Serum Vitamin ◽

Allelic Variant ◽

Serum Vitamin D ◽

Vitamin D Levels ◽

Multiple Sclerosis Patients

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Combining clinical and magnetic resonance imaging markers enhances prediction of 12-year disability in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458516642314 ◽

2016 ◽

Vol 23 (1) ◽

pp. 51-61 ◽

Cited By ~ 24

Author(s):

Tomas Uher ◽

Manuela Vaneckova ◽

Lukas Sobisek ◽

Michaela Tyblova ◽

Zdenek Seidl ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Multiple Sclerosis ◽

Magnetic Resonance ◽

Cumulative Risk ◽

Resonance Imaging ◽

Cox Models ◽

T2 Lesions ◽

Therapeutic Decisions ◽

The Individual

Background: Disease progression and treatment efficacy vary among individuals with multiple sclerosis. Reliable predictors of individual disease outcomes are lacking. Objective: To examine the accuracy of the early prediction of 12-year disability outcomes using clinical and magnetic resonance imaging (MRI) parameters. Methods: A total of 177 patients from the original Avonex-Steroids-Azathioprine study were included. Participants underwent 3-month clinical follow-ups. Cox models were used to model the associations between clinical and MRI markers at baseline or after 12 months with sustained disability progression (SDP) over the 12-year observation period. Results: At baseline, T2 lesion number, T1 and T2 lesion volumes, corpus callosum (CC), and thalamic fraction were the best predictors of SDP (hazard ratio (HR) = 1.7–4.6; p ⩽ 0.001–0.012). At 12 months, Expanded Disability Status Scale (EDSS) and its change, number of new or enlarging T2 lesions, and CC volume % change were the best predictors of SDP over the follow-up (HR = 1.7–3.5; p ⩽ 0.001–0.017). A composite score was generated from a subset of the best predictors of SDP. Scores of ⩾4 had greater specificity (90%–100%) and were associated with greater cumulative risk of SDP (HR = 3.2–21.6; p < 0.001) compared to the individual predictors. Conclusion: The combination of established MRI and clinical indices with MRI volumetric predictors improves the prediction of SDP over long-term follow-up and may provide valuable information for therapeutic decisions.

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Brain atrophy and employment in multiple sclerosis patients: a 10-year follow-up study

Multiple Sclerosis Journal - Experimental Translational and Clinical ◽

10.1177/2055217320902481 ◽

2020 ◽

Vol 6 (1) ◽

pp. 205521732090248

Author(s):

Cecilie Jacobsen ◽

Robert Zivadinov ◽

Kjell-Morten Myhr ◽

Turi O Dalaker ◽

Ingvild Dalen ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Multiple Sclerosis ◽

Magnetic Resonance ◽

Grey Matter ◽

Resonance Imaging ◽

Cortical Volume ◽

Deep Grey Matter ◽

Multiple Sclerosis Patients ◽

The Unemployed

Background Multiple sclerosis is often associated with unemployment. The contribution of grey matter atrophy to unemployment is unclear. Objectives To identify magnetic resonance imaging biomarkers of grey matter and clinical symptoms associated with unemployment in multiple sclerosis patients. Methods Demographic, clinical data and 1.5 T magnetic resonance imaging scans were collected in 81 patients at the time of inclusion and after 5 and 10 years. Global and tissue-specific volumes were calculated at each time point. Statistical analysis was performed using a mixed linear model. Results At baseline 31 (38%) of the patients were unemployed, at 5-year follow-up 44 (59%) and at 10-year follow-up 34 (81%) were unemployed. The unemployed patients had significantly lower subcortical deep grey matter volume ( P < 0.001), specifically thalamus, pallidus, putamen and hippocampal volumes, and cortical volume ( P = 0.011); and significantly greater T1 ( P < 0.001)/T2 ( P < 0.001) lesion volume than the employed patient group at baseline. Subcortical deep grey matter volumes, and to a lesser degree cortical volume, were significantly associated with unemployment throughout the follow-up. Conclusion We found significantly greater atrophy of subcortical deep grey matter and cortical volume at baseline and during follow-up in the unemployed patient group. Atrophy of subcortical deep grey matter showed a stronger association to unemployment than atrophy of cortical volume during the follow-up.

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Demographic Characteristics, Risk Factors, and Presenting Features of Children with Symptomatic Nutritional Rickets: A French Series

Hormone Research in Paediatrics ◽

10.1159/000511419 ◽

2020 ◽

Vol 93 (5) ◽

pp. 304-312

Author(s):

Claire Flot ◽

Valérie Porquet-Bordes ◽

Justine Bacchetta ◽

Anya Rothenbuhler ◽

Anne Lienhardt-Roussie ◽

...

Keyword(s):

Risk Factors ◽

Vitamin D ◽

Pediatric Population ◽

Vitamin D Supplementation ◽

Demographic Characteristics ◽

Total Serum ◽

Nutritional Rickets ◽

Total Serum Calcium ◽

Vitamin D Levels ◽

25 Hydroxy Vitamin D

Aim: To describe the demographic characteristics, risk factors, and presenting features of children with symptomatic nutritional rickets in France. Methods: This is a retrospective study of 38 children diagnosed with nutritional rickets from 1998 to 2019. Results: We observed a higher frequency of rickets in males (74 vs. 26%), in young children (median age at diagnosis: 23 months; 82% were younger than 5 years), and in children with a non-Caucasian ethnic background (89%). Most children were exclusively breastfed (78%) without adequate vitamin D supplementation (89%). The most common presentations were bowed legs (63%), hypocalcemic seizures (21%), and growth retardation (11%). Approximately half (62%) of the children were hypocalcemic. The children presenting with hypocalcemic seizures were significantly younger (0.8 vs. 2.2 years; p = 0.041) and had lower total serum calcium levels (1.44 vs. 2.17 mmol/L; p < 0.0001), higher phosphatemia (1.43 vs. 1.23 mmol/L; p = 0.020), and lower 25-hydroxy vitamin D levels (3 vs. 7 ng/mL; p = 0.020) but similar parathyroid hormone levels (357 vs. 289 ng/mL; p = 0.940) compared to rickets cases who did not experience hypocalcemic seizures. A dilated cardiomyopathy was detected in 14% of the children who had undergone echocardiography. Conclusion: Nutritional rickets remains endemic in the pediatric population and its most severe forms can have life-threatening sequelae. Health practitioners need to be cognizant of these facts to raise awareness and screen high-risk populations.

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Effectiveness of Vitamin D Supplementation in the Management of Multiple Sclerosis: A Systematic Review

International Journal of Molecular Sciences ◽

10.3390/ijms20061301 ◽

2019 ◽

Vol 20 (6) ◽

pp. 1301 ◽

Cited By ~ 12

Author(s):

Monika Berezowska ◽

Shelly Coe ◽

Helen Dawes

Keyword(s):

Multiple Sclerosis ◽

Vitamin D ◽

Vitamin D Supplementation ◽

Eligibility Criteria ◽

Serious Adverse Events ◽

Baseline Serum ◽

Lower Baseline ◽

Vitamin D Levels ◽

Disability Status ◽

Randomised Control Trials

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.

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Relationship between 25-OH-D serum level and relapse rate in multiple sclerosis patients before and after vitamin D supplementation

Therapeutic Advances in Neurological Disorders ◽

10.1177/1756285612447090 ◽

2012 ◽

Vol 5 (4) ◽

pp. 187-198 ◽

Cited By ~ 44

Author(s):

Charles Pierrot-Deseilligny ◽

Sophie Rivaud-Péchoux ◽

Pierre Clerson ◽

Raphaël de Paz ◽

Jean-Claude Souberbielle

Keyword(s):

Multiple Sclerosis ◽

Vitamin D ◽

Serum Level ◽

Relapse Rate ◽

Vitamin D Supplementation ◽

Before And After ◽

Multiple Sclerosis Patients

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Impact of Vitamin D Therapy on the Progress COVID-19: Six Weeks Follow-Up Study of Vitamin D Deficient Elderly Diabetes Patients

Proceedings of Singapore Healthcare ◽

10.1177/20101058211041405 ◽

2021 ◽

pp. 201010582110414

Author(s):

Amin R. Soliman ◽

Tarek Samy Abdelaziz ◽

Ahmed Fathy

Keyword(s):

Vitamin D ◽

Large Scale ◽

Clinical Laboratory ◽

Vitamin D Supplementation ◽

Chronic Obstructive ◽

Vitamin D Levels ◽

Significant Difference ◽

Patients With Diabetes ◽

Diabetes Patients

Background Coronavirus disease-19 (COVID-19) is an ongoing pandemic causing considerable fatalities worldwide. Vitamin D modulates the immune response through effects on various cells, such as: macrophages, B and T lymphocytes, neutrophils, and dendritic cells. Aim To explore whether supplementation of vitamin D, in the form of a single intramuscular cholecalciferol injection, to patients with diabetes, COVID-19, and low vitamin D levels could improve the prognosis of those patients. Methods This was a placebo-controlled randomized prospective study. The study has two arms as follows: the intervention arm (40 vitamin D deficient diabetes elderly patients that acquired SARS-CoV-2), compared to the control arm (16 elderly diabetes patients, with deficient vitamin D with SARS-CoV-2). Patients in the intervention arm were given vitamin D as a single intramuscular injection (200,000 IU); patients in the control arm were given placebo. The primary outcome was mortality within 6 weeks of the diagnosis of COVID-19. Clinical, laboratory, treatment, and outcome data were recorded after 6 weeks of follow-up. Results No significant difference in 6 weeks mortality was observed between patients who received vitamin D and patients who received placebo (17.5% vs 18.8%, p = 0.838). Age, presence of hypertension, and chronic obstructive pulmonary disease were independent predictors of mortality at 6 weeks. Conclusion Vitamin D supplementation did not reduce the severity or mortality of COVID-19 at 6 weeks. Further large scale studies are required to explore the effect of vitamin D therapy on survival in patients with diabetes mellitus who acquire COVID-19.

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