Research: Vitamin D levels and Relapse

Pierrot-Deseilligny et al. Relationship between 25-OH-D serum level and relapse rate in multiple sclerosis patients before and after vitamin D supplementation. Ther Adv Neurol Disord. 2012;5(4):187-98.

 BACKGROUND: Vitamin D could play a protective role in multiple sclerosis.

METHODS: In an observational, uncontrolled study, vitamin D3 supplementation (3010 IU/day on average) was given to 156 consecutive patients with relapsing-remitting multiple sclerosis, under first-line immunomodulatory therapy and with initial 25-OH-D serum level lower than 100 nmol/l (40 ng/ml). Relapses were determined for 29.1 ± 8.4 months during vitamin D and 29.8 ± 10.1 months before supplementation. The 25-OH-D level was measured before supplementation and several times during supplementation. The incidence rate of relapses before and during supplementation was estimated with follow-up durations as offset terms. The incidence rate and incidence rate ratio of relapses at various 25-OH-D levels were also calculated.

RESULTS: In 76 patients, immunomodulatory therapy preceded vitamin D supplementation (by 4.2 ± 2.7 years) and in 80 patients both treatments were started simultaneously. Under supplementation, the 25-OH-D level increased from 49 ± 22 nmol/l to 110 ± 26 nmol/l on average. Pooling data collected before and during supplementation, we found a significant strong inverse relationship between the relapse incidence rate and the 25-OH-D level (p < 0.0001), suggesting that vitamin D did indeed influence the relapse rate. Every 10 nmol increase in 25-OH-D level was associated with a reduction in the relapse incidence rate of 13.7%. 

CONCLUSION: Dividing iteratively the population made up of pooled periods into two subgroups according to the 25-OH-D levels, the relapse incidence rate ratio decreased.

This is yet more evidence for the value of Vitamin D supplementaion. It shows that supplementation increases  vitamin D levels and the more the higher the level of vitamin D in the blood the less relapses there were.

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  • Funny enough I read on Monday a ;piece published on Narrowband UVB light and MS.

    I am considering supplementing my oral "supplements" of D3 with a 10 mins exposure to the light itself (bloody sunshine in the UK).

    I am still research this topic and your advice will be much helpful (very pricey and cancer risk?)

    Why? pills are not enough for me – they are not raising my levels to the desired target despite the very high dose I take daily…

  • Re: "pills are not enough for me – they are not raising my levels to the desired target despite the very high dose I take daily… "

    Low levels may be due to genetic factors; some MSers have a problem with the enzyme that activates vD.

    Ramagopalan, et al. Rare variants in the CYP27B1 gene are associated with multiple sclerosis. Ann Neurol. 2011 Dec;70(6):881-6.

  • Yes, I also can't rise my VitD levels despite tablets and sunshine. Is there anything one can do even if one is probably genetically disadvantaged?

  • Re: "Is there anything one can do even if one is probably genetically disadvantaged?"

    Yes, you have to take the active form of vD; i.e. CALCITRIOL or 1,25-Dihydroxycholecalciferol. This is a prescription only medication and needs to closely monitored. This form of vD is the one that can cause high calcium levels. This is usually prescribed by nephrologists (renal patients) or endocrinologists (bone doctors)

  • if a patient with 20nmol/l of vitamin d initially, increases vitamin d to 120 nmol/l, number of relapses decreased 137%???it is impossible. can you explain better the conclusions of the study (10nmol-13,7%)?

  • This linear relationship between reduction in relapses and vit d levels may have had an upper limit.
    But what is our best guess on this upper limit with the knowledge we have today? That is really the question.
    150nmol/l? 200nmol/l? 250nmol/l?

    The average patient increased levels from 50nmol/l to 110nmol/l which translates into a 80% reduction.

    Would you, Prof G, in case you were the one with ms supplement your 5000IU vit d with exposure to sunlight (either from sunbed or directly from the sun).

    I know about the skin cancer risk and all that but if we could just gain some marginal effect from the sun/sunbed would that not outweigh this risk?

    And yes, I know its not been through controlled trials and all that but with MS we sometimes need to take some controlled risk.

    btw, a great blog this one!
    Thank you.

  • I could not work out where the 137% came from to start but then realise this 20 to 120 so 100 level change so 10 x 13.7% = 137%.

    In the study the level goes from 50-110 this change of 60 so 6 x 13.7 = 82.2% and this was based on analysis of two different groups.

  • 82,2%? then, supplementation with vitamin D, according to this study, is the most powerful remedy for MS?tysabri reduces relapses in 68%.thank you very much

  • Re: "82,2%? then, supplementation with vitamin D, according to this study, is the most powerful remedy for MS?tysabri reduces relapses in 68%.thank you very much"

    This is an uncontrolled study; it is observational and participants were not randomised. We can't make treatment decisions based on this data. This study would be classed s class 3 evidence.

    There is a scientific rationale to support us having vD levels above 100nmol/L without a seasonal variation. This is the pattern hunter-gatherer societies living in Africa have. This is why I take 5,000U of vD3 365 days of the year, regardless of my sun exposure.

  • Erm, just looked up what I have been using – colecalciferol 1000 I.E. all along 1 tablet per day (got it from mama who got it for oestheoporosis). Still last time I checked blood the level was 38 n/l VD. Good to know that I need to monitor calcium levels with this one – however, can I safely take 2 tablets of my stuff then?

  • Now I am confused. In previous discussions we were told to make sure we took Vit D3 and not D2.

    I thought Colecalciferol was D3???

    What kind of Vit D are you taking 5000 IU a day?


  • Re: "I thought Colecalciferol was D3?"

    Yes, it is! vD3 comes in an inactive form, which is the one that you buy over the counter, and an active form that is a prescription only medication. The latter is prescribed for people who have renal disease or lack the enzyme that converts the inactive form to the active form.

    Vitamin D2 is called ergocalciferol.

    I take the inactive form of vD3, which is cholecalciferol or colecalciferol. The active form is calcitriol or dihydroxycholecalciferol.

    The confusion is my mistake; colecalciferol of kern pharma is the inactive form.

    You may want to read about vD in wikipedia:

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