Comparative Effectiveness of a Six-Week Treatment Course of Vitamin D₂ and D₃ in Children With Sickle Cell Anemia in Steady State With Hypovitaminosis D: A Randomized Clinical Trial

Abstract

Background Correction of vitamin D deficiency through administration of either vitamin D 2 or D 3 has been shown to reduce chronic bone pains and frequency of acute bone pains, increase bone density as well as improve growth stature in children with sickle cell anemia (SCA). Findings vary on the effectiveness of the two forms of the vitamin. The current study was carried out to compare the effectiveness of a 6-week treatment course of vitamin D 2 and D 3 in the correction of hypovitaminosis D (vitamin D insufficiency and deficiency) as well as evaluate treatment response to derangement of serum calcium and alkaline phosphatase (ALP) in children with SCA in steady state. Methods The study was a randomized, double-blind clinical trial of 174 children with SCA aged 1 - 18 years. Subjects with hypovitaminosis D (baseline serum 25-hydroxyvitamin D (25(OH)D) below 75 nmol/L) were randomized into two treatment arms. Each arm treated either of the two forms of vitamin D had a once weekly dose of 50,000 IU for a period of 6 weeks. Results Median rise in serum 25(OH)D after 6 weeks of oral vitamin D 2 or D 3 was similar between the two groups (median rise in 25(OH)D of 17.8 nmol/L in D 2 , 15.3 nmol/L in D 3 groups). Also, there was no significant difference in the proportion of subjects that improved in their vitamin D status in both treatment arms (P = 0.409). Treatment was significantly associated with increase in proportion of subjects with normal serum calcium (P ≤ 0.001) and decrease in proportion of subjects with elevated serum ALP (P ≤ 0.001). Conclusion Once weekly dose (50,000 IU) of either vitamin D supplement has equal effectiveness in correction of hypovitaminosis D. However, vitamin D 3 may be cost-effective because it is cheaper.

Defining vitamin D deficiency in patients with sickle cell disease; A meta-analysis

“…Initial research on pediatric SCD patients found that their risk of developing VDD is 5.3 times higher than that of healthy individuals (12). This has been supported by a recent study, which found that SCD patients had a five times higher risk of VDD than the general population (15,34). Further, children with SCD-SS were at higher risk for low vitamin D status in the spring season (35).…”

The Association between Standardized Serum 25-Hydroxyvitamin D Concentration and Risk of Anemia: A Population-Based Cross-Sectional Study

“…In recent years, studies of the relationship between 25(OH)D and anemia have focused on sickle cell anemia, and have demonstrated that 25(OH)D supplementation is helpful in treatment of sickle cell anemia [16,18,[21][22][23]; however, the overall relationship between 25(OH)D and anemia, particularly its trend, has not been clarified. Our study revealed a U-shaped relationship between serum 25(OH)D levels and risk of anemia, and with increased 25(OH)D level, hemoglobin level, and RBC counts the association showed a downward trend, suggesting that caution should be applied in the use of 25(OH)D supplementation to treat anemia.…”

Hypothesis: Low Vitamin A and D Levels Worsen Clinical Outcomes When Children with Sickle Cell Disease Encounter Parvovirus B19

“…Might vitamin supplementation prevent or treat disease caused by parvovirus B19? A number of vitamin supplementation studies, most often with vitamin D, have been performed and have indicated benefit in patients with SCD, including a reduction in respiratory illness [73][74][75][76][77][78][79][80]. Nonetheless, study results have been mixed.…”