Why vitamin D supplementation is not a general advice in MS
ECTRIMS Online Library. Smolders J. 09/11/19; 279380; 28
Joost Smolders
Joost Smolders
Contributions
Abstract

Abstract: 28

Type: Hot Topic

Abstract Category: Hot Topic 3: Should we recommend vitamin D supplementation to our MS

J. Smolders1,2

1Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, 2Neuroimmunology researchgroup, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands

Vitamin D3 supplementation has a consolidated role in the promotion of a healthy bone metabolism in individuals with low circulating 25-hydroxyvitamin D (25(OH)D) levels. Low circulating levels of 25(OH)D predict a higher risk of relapses and active MRI lesions in several cohorts with early relapsing remitting multiple sclerosis (RRMS). Anti-inflammatory properties of its active metabolite are used for the justification of vitamin D3 supplementation in MS to improve these outcomes. However, the efficacy of this intervention is uncertain. Circumstantial evidence suggests that inflammation lowers circulating 25(OH)D levels. Additionally, sunlight exposure has immune suppressing properties by itself independent of 25(OH)D levels. Although genetic evidence suggests a qualitative effect of 25(OH) levels on MS risk, this does not provide a quantitative estimate regarding the effect of vitamin D supplements on relapses and MRI lesions. Small controlled supplementation studies are negative on their primary endpoints, and do not provide consistently reproducible signals on the modulation of relevant circulating biomarker levels. Although secondary endpoints provide signals of potential benefits in vitamin D3-supplemented treatment arms, these are modest to negligible compared to the highly-effective disease modifying treatments which are used in daily practice to treat early RRMS. In conclusion, there may be a role for vitamin D3 supplementation in RRMS patients with low 25(OH)D levels to promote bone health. Convincing data that vitamin D3 supplements have a meaningful impact on the earlier mentioned MS disease outcomes are lacking, and this should therefore not be regarded as standard practice.
Disclosure: Joost Smolders received speaker and/or consultancy fees from Biogen, Genzyme, Merck and Novartis.

Abstract: 28

Type: Hot Topic

Abstract Category: Hot Topic 3: Should we recommend vitamin D supplementation to our MS

J. Smolders1,2

1Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, 2Neuroimmunology researchgroup, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands

Vitamin D3 supplementation has a consolidated role in the promotion of a healthy bone metabolism in individuals with low circulating 25-hydroxyvitamin D (25(OH)D) levels. Low circulating levels of 25(OH)D predict a higher risk of relapses and active MRI lesions in several cohorts with early relapsing remitting multiple sclerosis (RRMS). Anti-inflammatory properties of its active metabolite are used for the justification of vitamin D3 supplementation in MS to improve these outcomes. However, the efficacy of this intervention is uncertain. Circumstantial evidence suggests that inflammation lowers circulating 25(OH)D levels. Additionally, sunlight exposure has immune suppressing properties by itself independent of 25(OH)D levels. Although genetic evidence suggests a qualitative effect of 25(OH) levels on MS risk, this does not provide a quantitative estimate regarding the effect of vitamin D supplements on relapses and MRI lesions. Small controlled supplementation studies are negative on their primary endpoints, and do not provide consistently reproducible signals on the modulation of relevant circulating biomarker levels. Although secondary endpoints provide signals of potential benefits in vitamin D3-supplemented treatment arms, these are modest to negligible compared to the highly-effective disease modifying treatments which are used in daily practice to treat early RRMS. In conclusion, there may be a role for vitamin D3 supplementation in RRMS patients with low 25(OH)D levels to promote bone health. Convincing data that vitamin D3 supplements have a meaningful impact on the earlier mentioned MS disease outcomes are lacking, and this should therefore not be regarded as standard practice.
Disclosure: Joost Smolders received speaker and/or consultancy fees from Biogen, Genzyme, Merck and Novartis.

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