Higher 25‐hydroxyvitamin D levels are associated with greater odds of remission with anti‐tumour necrosis factor‐α medications among patients with inflammatory bowel diseases

Abstract

Background Vitamin D has been linked to disease activity among patients with inflammatory bowel diseases (IBD). Prior investigation has also suggested that vitamin D levels may affect duration of therapy with anti-tumor necrosis factor-α (anti-TNF-α) medications among patients with IBD. Aims This study aimed to evaluate the relationship between vitamin D levels and odds of reaching remission while on an anti-TNF-α medication. Methods 521 IBD patients enrolled in the Brigham and Women’s IBD Center database were eligible for inclusion. Patients treated with anti-TNF-α therapy who had vitamin D levels drawn within 6 months prior or 2 weeks after initiation of anti-TNF-α medication and who had reported remission status at 3 months were included. A logistic regression model adjusting for age, gender, IBD diagnosis, anti-TNF-α medication (infliximab versus adalimumab) and first or subsequent anti-TNF-α medication was used to identify the effect of vitamin D level on initial response to anti-TNF-α therapy. Results 173 patients were included in the final analysis. On logistic regression, patients with normal vitamin D levels at the time of anti-TNF-α medication initiation had a 2.64 increased odds of remission at 3 months compared to patients with low vitamin D levels when controlling for age, gender, diagnosis, type of anti-TNF-α medication and first or subsequent anti-TNF-α medication (OR 2.64, 95% CI 1.31–5.32, p 0.0067). Conclusion These findings suggest that vitamin D levels may influence initial response to anti-TNF-α medication and that low vitamin D levels may predispose patients to decreased odds of remission.

Systematic review with meta‐analysis: association of vitamin D status with clinical outcomes in adult patients with inflammatory bowel disease

“…Out of 1351 citations, 27 articles comprising of 8316 IBD patients met our predefined inclusion and exclusion criteria. The PRISMA flow diagram is presented in Figure .…”

“…For the outcome of clinical relapse, 11 studies met inclusion criteria and included a total of 5,507 patients . There was no evidence of publication bias based on funnel plot asymmetry (Figure S1B, Egger's Test P = .421).…”

“…Low vitamin D status was defined by vitamin D deficiency thresholds set by individuals studies. Most of our included studies defined low 25(OH)D with a serum level < 20 ng/mL (19 studies). Five studies defined low 25(OH)D as <30 ng/mL.…”

“…The same study demonstrated that IBD patients also had increased odds of lower vitamin D levels compared to matched controls. Due to the potential mechanistic link between vitamin D and colitis and the high prevalence of vitamin D deficiency in IBD patients, many groups have sought to examine the impact of vitamin D levels on IBD clinical outcomes, often with conflicting results. Many of these previous studies were limited by their small sample size and inability to detect differences in clinical outcomes between low and high vitamin D groups.…”

Vitamin D and Ulcerative Colitis: Is There a Relationship with Disease Extent?

“…In CD, patients receiving anti-TNF therapy has been shown to result in improved levels of vitamin D [5]. Different studies demonstrate that patients with lower vitamin D levels at diagnosis usually have a more severe disease course [33,34]. There is a high incidence of insufficient or deficient vitamin D levels in patients with UC and ileal pouch-anal anastomosis [35].…”