scholarly journals Vitamin D as Modulator of Drug Concentrations: A Study on Two Italian Cohorts of People Living with HIV Administered with Efavirenz

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3571
Author(s):  
Jessica Cusato ◽  
Massimo Tempestilli ◽  
Andrea Calcagno ◽  
Alessandra Vergori ◽  
Pierluca Piselli ◽  
...  

To date, vitamin D seems to have a significant role in affecting the prevention and immunomodulation in COVID-19 disease. Nevertheless, it is important to highlight that this pro-hormone has other several activities, such as affecting drug concentrations, since it regulates the expression of cytochrome P450 (CYP) genes. Efavirenz (EFV) pharmacokinetics is influenced by CYPs, but no data are available in the literature concerning the association among vitamin D levels, seasonality (which affects vitamin D concentrations) and EFV plasma levels. For this reason, the aim of this study was to evaluate the effect of 25-hydroxy vitamin D (25(OH)D3) levels on EFV plasma concentrations in different seasons. We quantified 25(OH)D3 by using chemiluminescence immunoassay, whereas EFV plasma concentrations were quantified with the HPLC–PDA method. A total of 316 patients were enrolled in Turin and Rome. Overall, 25(OH)D3levels resulted in being inversely correlated with EFV concentrations. Some patients with EFV levels higher than 4000 ng/mL showed a deficient 25(OH)D3 concentration in Turin and Rome cohorts and together. EFV concentrations were different in patients without vitamin D supplementation, whereas, for vitamin D-administered individuals, no difference in EFV exposure was present. Concerning seasonality, EFV concentrations were associated with 25(OH)D3 deficiency only in winter and in spring, whereas a significant influence was highlighted for 25(OH)D3 stratification for deficient, insufficient and sufficient values in winter, spring and summer. A strong and inverse association between 25(OH)D3and EFV plasma concentrations was suggested. These data suggest that vitamin D is able to affect drug exposure in different seasons; thus, the achievement of the clinical outcome could be improved by also considering this pro-hormone.

Nutrients ◽  
2019 ◽  
Vol 12 (1) ◽  
pp. 99 ◽  
Author(s):  
Christian Legarth ◽  
Daniela Grimm ◽  
Marcus Krüger ◽  
Manfred Infanger ◽  
Markus Wehland

Vitamin D plays a pivotal role in bone homeostasis and calcium metabolism. However, recent research has indicated additional beneficial effects of vitamin D on the cardiovascular system. This review aims to elucidate if vitamin D can be used as an add-on treatment in coronary artery disease (CAD). Large-scale epidemiological studies have found a significant inverse association between serum 25(OH)-vitamin D levels and the prevalence of essential hypertension. Likewise, epidemiological data have suggested plasma levels of vitamin D to be inversely correlated to cardiac injury after acute myocardial infarction (MI). Remarkably, in vitro trials have showed that vitamin D can actively suppress the intracellular NF-κB pathway to decrease CAD progression. This is suggested as a mechanistic link to explain how vitamin D may decrease vascular inflammation and atherosclerosis. A review of randomized controlled trials with vitamin D supplementation showed ambiguous results. This may partly be explained by heterogeneous study groups. It is suggested that subgroups of diabetic patients may benefit more from vitamin D supplementation. Moreover, some studies have indicated that calcitriol rather than cholecalciferol exerts more potent beneficial effects on atherosclerosis and CAD. Therefore, further studies are required to clarify these assumptions.


2020 ◽  
Vol 93 (5) ◽  
pp. 304-312
Author(s):  
Claire Flot ◽  
Valérie Porquet-Bordes ◽  
Justine Bacchetta ◽  
Anya Rothenbuhler ◽  
Anne Lienhardt-Roussie ◽  
...  

<b><i>Aim:</i></b> To describe the demographic characteristics, risk factors, and presenting features of children with symptomatic nutritional rickets in France. <b><i>Methods:</i></b> This is a retrospective study of 38 children diagnosed with nutritional rickets from 1998 to 2019. <b><i>Results:</i></b> 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; <i>p</i> = 0.041) and had lower total serum calcium levels (1.44 vs. 2.17 mmol/L; <i>p</i> &#x3c; 0.0001), higher phosphatemia (1.43 vs. 1.23 mmol/L; <i>p</i> = 0.020), and lower 25-hydroxy vitamin D levels (3 vs. 7 ng/mL; <i>p</i> = 0.020) but similar parathyroid hormone levels (357 vs. 289 ng/mL; <i>p</i> = 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. <b><i>Conclusion:</i></b> 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.


2019 ◽  
Vol 5 (1) ◽  
pp. 205521731982659 ◽  
Author(s):  
Johan Linden ◽  
Gabriel Granåsen ◽  
Jonatan Salzer ◽  
Anders Svenningsson ◽  
Peter Sundström

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.


2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
Jonathan D. Adachi ◽  
Jacques P. Brown ◽  
George Ioannidis

Though vitamin D is important for bone health, little is known about the monitoring and management of vitamin D levels in patients with osteoporosis in clinical practice—a deficit this chart review initiative aimed to remedy. A total of 52 physicians completed profiles for 983 patients being treated for osteoporosis between November 2008 and April 2009. Information collected included demographics; fracture risk factors; availability and level of serum vitamin D measurements; and information on osteoporosis medications and calcium and vitamin D supplementation. Physicians also evaluated patients’ current regimens and detailed proposed changes, if applicable. Nearly 85% of patients were prescribed calcium and vitamin D supplements. Serum 25-hydroxy vitamin D levels were available for 73% of patients. Of these patients, approximately 50% had levels less than 80 nmol/L, which contrasts with the 37% thought to have “unsatisfactory” vitamin D levels based on physician perceptions. Physicians felt 26% of patients would benefit from additional vitamin D supplementation. However, no changes to the osteoporosis regimen were suggested for 48% of patients perceived to have “unsatisfactory” vitamin D levels. The results underscore the importance of considering vitamin D status when looking to optimize bone health.


2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Bing Han ◽  
Qin Li ◽  
Ningjian Wang ◽  
Yi Chen ◽  
Chunfang Zhu ◽  
...  

Background. The relationship between vitamin D and insulin resistance is still controversial. Many factors could influence this relationship. In addition, this relationship in different genders was still unclear. Methods. A total of 6597 subjects, including 2813 males and 3784 females, were analyzed. The serum levels of 25(OH)D, fasting blood glucose (FBG), fasting insulin, HbA1c, and other metabolic parameters were tested. The waist circumference (WC), weight, and height were also measured. Questionnaires regarding smoking and drinking were collected from these subjects. Results. Serum 25(OH)D was categorized into quartiles. Increasing 25(OH)D levels were associated with reduced trend of homeostasis model assessment of insulin resistance (HOMA-IR) in both males and females. Pearson’s correlation indicated 25(OH)D level was inversely associated with the HOMA-IR for male subjects (r=−0.055, P=0.028) but not for female subjects (r=−0.005, P=0.798). Age, triglyceride (TG), and low-density lipoprotein (LDL) were associated with the vitamin D levels in males and females. In regression analysis, serum 25(OH)D concentration was significantly associated with HOMA-IR only in overweight males. Conclusion. We found an inverse association between 25(OH)D and HOMA-IR in Chinese overweight males. Vitamin D supplementation might be beneficial in this population. However, further clinical trials are needed to confirm this association.


Author(s):  
Emel Torun ◽  
Feyza Ustabas Kahraman ◽  
Nurcan Keskin Osmanoğlu ◽  
Mehmet Kucukkoc ◽  
Tugrul Donmez ◽  
...  

Abstract: We aim to evaluate how vitamin D-containing supplements affect the vitamin D status of children 1–3 years old and to assess the variation of the vitamin D concentrations across different seasons.This retrospective study included a review of medical reports of 1035 patients (aged 1–3 years) who presented to our hospital between October 2011 and October 2013. The children were divided into 3 groups: Group 1: those supplemented with vitamin DGender distribution was not statistically different between the three groups (p=0.38). The children who had taken vitamin D-containing supplements had significantly higher vitamin D levels compared with the children who were given no vitamin D supplementation (p<0.001). Children with no vitamin D supplementation had significantly lower calcium and phosphorus levels compared with Groups 1 and 2. Vitamin D levels were affected by vitamin D supplementation (f=16.125, p<0.001) but not by season (f=0.699, p=0.650).The children aged 1–3 years who did not receive vitamin D-containing supplements had insufficient vitamin D and low levels of calcium and phosphorus. Vitamin D levels were affected by vitamin D supplementation but not by season.


Author(s):  
Mahesh Kumar Singh

Introduction: Type 2 diabetes mellitus (T2DM) is a major public health problem, with an estimated 65 million patients in India. Studies shown that low serum 25(OH)D concentrations are associated with an increased risk of type 2 diabetes and shown the beneficial effect of vitamin D supplementation on insulin sensitivity. Vitamin D is formed in humans by subcutaneous photosynthesis from its precursor, 7-dehydrocholesterol by exposing themselves to the sun. older age is associated with a decrease in 7-dehydrocholesterol concentration in the human skin. This lifestyle habit and their natural diet of low vitamin D consumption may cause poor glucose control in diabetic patients. The purpose of this study was to examine the association between serum 25(OH)D and glycosylated hemoglobin (HbA1c) levels. Material and Methods: This was a prospective observational study of T2DM patients aged 18 and above who attended the outpatient clinics of a tertiary center. The following variables were collected from the cases: age, sex, type of diabetes, HbA1c result. Baseline HbA1c and vitamin D levels were recorded prior to supplementation and after a period of 6 months of supplementation with vitamin D, HbA1c and vitamin D levels were recorded once again.  Results: A total of 169 patients were included in the study and whose follow up was completed at the end of 6 months. Mean age of the study population was 46.87 ± 15.99. there were 74(43.79%) male and 95(56.21%) female.  Mean HbA1c pre-supplementation (%) was   9.58 ± 2.41 while post supplementation was 7.21 ± 1.08. There was a significant reduction of HbA1c of T2DM (P < 0.0001). Vitamin D levels pre-supplementation (nmol/L) (mean ± SD) was 38.54 ± 29.54 while, Vitamin D levels post-supplementation (nmol/L) (mean ± SD) was 38.54  ± 29.54. There was a significant increase of vitamin D levels of T2DM (P < 0.0001). Conclusion: Significant inverse association between vitamin levels D and HbA1c in T2DM patients was observed. Also there was significant reduction in HbA1c as vitamin D levels increased. Regular screening of vitamin levels D and HbA1c in T2DM patients is advised. Keywords: Vitamin D, diabetes, T2DM, 25-hydroxyvitamin D


2012 ◽  
Vol 52 (1) ◽  
pp. 16
Author(s):  
Ayi Dilla Septarini ◽  
Taralan Tambunan ◽  
Pustika Amalia

Background Children with frequently relapsing and steroiddependentnephrotic syndrome (FRNS/SDNS) are at riskfor osteoporosis due to impaired metabolism of calcium andvitamin D.Objective To determine the effect of calcium and vitamin Dsupplementation on bone mineral density, serum ionized calciumlevels and serum 25-hydroxy-vitamin D levels in children withFRNS and SDNS.Methods A clinical trial with a before and after design wasperformed. Subjects were SDNS or FRNS pediatric patients 2: 5years of age. Subjects received 800 mg elemental calcium and 400IU vitamin D supplementation for 8 weeks. Serum ionized calcium,serum 25-hydroxy-vitamin D [25(0H)D], and bone mineral density(BMD) were determined before and after the supplementation.Results Of the 30 subjects, 28 completed the study. However,only 20 subjects underwent BMD determination before and aftersupplementation. Of the 28 subjects, 22 had hypocalcemia and 26had low vitamin D levels. Osteopenia was found in 14/20 subjects andosteoporosis was in 2/20 subjects. After 8 weeks of supplementation,mean serum ionized calcium increased from low [1.15 mmol/L (SDO.oJ)] to normal [1.18 mmol/L (SD 0.04)] (P< 0.001) levels, butmean serum 25(0H)D only increased from vitamin D deficiencycategory [20 ng/mL (SD 7 .7)] to vitamin D insufficiency category[25.5 ng/mL (7.7)] (P=0.010). Mean z-score BMD increased from-1.1 (SD 0.9) to -0.7 (SD 0.2) after supplementation (P<0.001).Conclusion Calcium vitamin D supplementation effectively increasedserum ionized calcium, serum 25 (OH)D, and BMD in subjectswith FRNS and SDNS. [Paediatr lndones. 2012;52:16-21].


2016 ◽  
Vol 86 (5-6) ◽  
pp. 169-183 ◽  
Author(s):  
Stavri Chrysostomou

There is currently insufficient evidence of a beneficial effect to recommend vitamin D supplementation for optimizing glycemic status in patients with type 2 diabetes mellitus (T2DM). Taking into consideration the significant extra-skeletal effect of vitamin D on pancreatic β-cell function and insulin secretion and the large number of scientific evidence supporting the inverse association between vitamin D status and hyperglycemia, this review article aims to examine whether vitamin D supplementation therapies are beneficial to patients with T2DM considering specific factors through randomized controlled trials (RCTs). EBSCOhost and Medline databases were searched from the beginning of 2009 until the end of 2014 for RCTs in patients with T2DM. Parameters, such as baseline vitamin D levels, frequency/dosage of supplementation, length of the study and type of supplementation, were independently assessed, based on their effect on glycemic status. Although all different types of supplementation were safe and effective in the achievement of vitamin D sufficiency in a dose-dependent way, the impact on glycemic status was different. 14 RCTs were included with daily supplementations ranging from 400-11.200 IU/daily, 40.000-50.000 IU/weekly and 100.000-300.000 IU/intramuscularly or once given, for a period from 8 to 24 weeks. Daily supplementation of vitamin D (up to 11.200 IU) showed no effect, whereas combined supplementation, with calcium (≥300 mg), and with vitamin D doses similar to the RDA, showed positive effects. Additionally, high weekly doses of vitamin D (40.000-50.000 IU) were effective on glycemic outcomes but available data are limited.


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