Effectiveness of Vitamin D Supplementation in the Management of Multiple Sclerosis: A Systematic Review

Abstract

Objective: to examine the extent of effect vitamin D in Multiple Sclerosis (MS) on pathology and symptoms. Methods: A literature search was performed in November 2018 (CRD42018103615). Eligibility criteria: randomised control trials in English from 2012 to 2018; a clinical diagnosis of MS; interventions containing vitamin D supplementation (vitamin D3 or calcitriol) in disease activity compared to a control/placebo; improvement in: serum 25(OH)D, relapse rates, disability status by Expanded Disability Status Scale (EDSS) scores, cytokine profile, quality of life, mobility, T2 lesion load and new T2 or T1 Gd enhancing lesions, safety and adverse effects. Risk of bias was evaluated. Results: Ten studies were selected. The study size ranged from 40 to 94 people. All studies evaluated the use of vitamin D supplementation (ranging from 10 to 98,000 IU), comparing to a placebo or low dose vitamin D. The duration of the intervention ranged from 12 to 96 weeks. One trial found a significant effect on EDSS score, three demonstrated a significant change in serum cytokines level, one found benefits to current enhancing lesions and three studies evaluating the safety and tolerability of vitamin D reported no serious adverse events. Disease measures improved to a greater extent overall in those with lower baseline serum 25(OH)D levels. Conclusions: As shown in 3 out of 10 studies, improvement in disease measures may be more apparent in those with lower baseline vitamin D levels.

Consensus statement from 2nd International Conference on Controversies in Vitamin D

“…To address these shortcomings, systematic reviews have been undertaken to examine the effect of vitamin D supplementation on MS; however, some of these have been limited by lack of a range of vitamin D status and not accounting for bias [167] or failure to assess cytokine outcomes or baseline vitamin D on outcomes [168]. A third systematic review has attempted to address some of these former weaknesses [169]. In this meta-analysis which included 10 studies, vitamin D supplementation was compared to placebo or low dose vitamin D. Overall, disease measures improved to a greater extent in patients with lower baseline serum 25(OH)D levels.…”

Role of Vitamin D in Preventing and Treating Selected Extraskeletal Diseases—An Umbrella Review

“…Overall, 11 records were included in this review [100,[204][205][206][207][208][209][210][211][212][213] (Supplemental Figure S6). We focused on publications that examined the association between vitamin D and the development of MS or clinical activity of MS. Supplemental Tables S22-S24 provide information about the included studies and the assessed quality based on AMSTAR 2.…”

“…Regarding clinical outcomes, eight publications that conducted SRs of mainly RCTs [204,205,207,[209][210][211][212][213] focused on changes in the expanded disability status scale (EDSS). In summary, the studies found no significant therapeutic effect of vitamin D on EDSS and/or concluded that vitamin D supplementation had no effects on EDSS.…”

“…Considering annualised relapse rate (ARR), researchers of four more recent studies [206,208,210,211,213] found that vitamin D did not reduce the number of relapses.…”

“…Data on MRI outcomes in RCTs regarding new T1 or T2 brain lesions is inconsistent. Some RCTs hint at a potential clinical treatment effect in favour of vitamin D, while others do not report a change in T1 or T2 brain lesions compared to the placebo group [204,207,210,211,213].…”