Vitamin D for the management of multiple sclerosis

• Published in: Cochrane database of systematic reviews 2018-09, Vol.9 (9), p.CD008422
• Main Authors: Jagannath, Vanitha A, Filippini, Graziella, Di Pietrantonj, Carlo, Asokan, G V, Robak, Edward W, Whamond, Liz, Robinson, Sarah A
• Format: Article
• Language: English
• Subjects: Cholecalciferol - therapeutic use; Ergocalciferols - therapeutic use; Fatigue - drug therapy; Humans; Medicine General & Introductory Medical Sciences; Multiple Sclerosis - drug therapy; Quality of Life; Randomized Controlled Trials as Topic; Vitamins - therapeutic use
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD008422.pub3

This review is an update of a previously published review, "Vitamin D for the management of multiple sclerosis" (published in the Cochrane Library; 2010, Issue 12). Multiple sclerosis (MS) is characterised by inflammation, demyelination, axonal or neuronal loss, and astrocytic gliosis in the central nervous system (CNS), which can result in varying levels of disability. Some studies have provided evidence showing an association of MS with low levels of vitamin D and benefit derived from its supplementation. To evaluate the benefit and safety of vitamin D supplementation for reducing disease activity in people with MS. We searched the Cochrane Multiple Sclerosis and Rare Diseases of the CNS Specialized Register up to 2 October 2017 through contact with the Information Specialist with search terms relevant to this review. We included references identified from comprehensive electronic database searches and from handsearches of relevant journals and abstract books from conferences. We included randomised controlled trials (RCTs) and quasi-RCTs that compared vitamin D versus placebo, routine care, or low doses of vitamin D in patients with MS. Vitamin D was administered as monotherapy or in combination with calcium. Concomitant interventions were allowed if they were used equally in all trial intervention groups. Two review authors independently extracted data and assessed the methodological quality of studies, while another review author sorted any disagreements. We expressed treatment effects as mean differences (MDs) for continuous outcomes (Expanded Disability Status Scale and number of magnetic resonance imaging (MRI) gadolinium-enhancing T1 lesions), as standardised MDs for health-related quality of life, as rate differences for annualised relapse rates, and as risk differences (RDs) for serious adverse events and minor adverse events, together with 95% confidence intervals (CIs). We identified 12 RCTs enrolling 933 participants with MS; 464 were randomised to the vitamin D group, and 469 to the comparator group. Eleven trials tested vitamin D₃, and one trial tested vitamin D₂. Vitamin D₃ had no effect on the annualised relapse rate at 52 weeks' follow-up (rate difference -0.05, 95% CI -0.17 to 0.07; I² = 38%; five trials; 417 participants; very low-quality evidence according to the GRADE instrument); on the Expanded Disability Status Scale at 52 weeks' follow-up (MD -0.25, 95% CI -0.61 to 0.10; I² = 35%; five trials; 221 participants; very low-quality e