Vitamin D is one of the biggest confounders in MS clinical trials. It’s like a chess piece, where every move has an effect on the outcome.
This latest piece of research from Romania studying the effect of Copaxone (immune modulator) versus prednisone (steroid) on circulating immune complexes (auto-antibodies) in RRMS, shows exactly this. The investigators found low serum levels of immune complexes in the Copaxone group after three months of treatment, but the vitamin D level was greater in the group on Copaxone versus those on steroids. The treatment effect on immune complexes therefore cannot be solely attributed to Copaxone!
We have been here before. In a previous study Vitamin D supplementation has been shown to reduce relapse rates in MS patients treated with natalizumab. Whilst, supplementing Vitamin D on Rebif (Interferon) treatment when levels were low to start with, resulted in lower relapse rates, less new MRI T1 lesions and lower EDSS (disability) progression.
Vitamin D is therefore probably one of biggest hidden gems in MS treatments
Exp Ther Med. 2021 May;21(5):542. doi: 10.3892/etm.2021.9974. Epub 2021 Mar 23.
Assessing the values of circulating immune complexes in multiple sclerosis patients following immunomodulator or corticosteroid treatment
Multiple sclerosis is defined as an immune-mediated disease that affects the central nervous system, and also is characterized by the presence of immune cells and mediators which contribute to the subsidiary neuroinflammation associated with multiple sclerosis. Throughout the evolution of multiple sclerosis, it has been observed that circulating immune complexes (CICs) have higher values in these patients, especially in the acute phase of the disease. Thus, the aim of the present study was to observe, if in acute attack, relapsing-remitting multiple sclerosis patients still present high values of CICs after treatment with glatiramer and prednisone. We divided 70 patients with multiple sclerosis with high values of CICs into two treatment groups, one treated with glatiramer (Copaxone) (immunomodulatory treatment) and the other with prednisone (corticosteroid treatment). After three months of treatment, we assessed the levels of CICs of the two multiple sclerosis groups and we observed that the patients that followed the immunomodulatory treatment had lower values of CICs than the group that followed the corticosteroid treatment. In addition, another observation established was that the glatiramer treatment group had higher levels of vitamin D in the serum than the prednisone group of multiple sclerosis patients. To conclude, better outcomes, from the point of view of the results obtained from the comparative analysis of the values of CICs and vitamin D, were demonstrated by following immunomodulatory treatment.