Vitamin D supplementation differentially affects seasonal multiple sclerosis disease activity

Miclea, Andrei; Miclea, Marius; Pistor, Maximilian; Hoepner, Andreas G. F.; Chan, Andrew; Hoepner, Robert

doi:10.1002/brb3.761

Cited by 24 publications

(17 citation statements)

References 25 publications

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“…Surprisingly, we found no consistent evidence of an association between post-FDE sun exposure and either MS conversion or relapse hazard, nor between postonset serum 25(OH)D levels and clinical course. These null findings were unexpected and inconsistent with other observations in support of a role for vitamin D in MS clinical course ( 20 – 24 , 26 , 27 , 51 – 53 ). It raises the question whether there truly is no association (affirming the null hypothesis) or whether the study failed to detect an association (a false negative).…”

Section: Discussioncontrasting

confidence: 99%

Sun Exposure across the Life Course Significantly Modulates Early Multiple Sclerosis Clinical Course

et al. 2018

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BackgroundLow vitamin D and/or sun exposure have been associated with increased risk of multiple sclerosis (MS) onset. However, comparatively, few studies have prospectively examined associations between these factors and clinical course.ObjectivesTo evaluate the association of sun exposure parameters and vitamin D levels with conversion to MS and relapse risk in a prospectively monitored cohort of 145 participants followed after a first demyelinating event up to 5-year review (AusLong Study).MethodsSun exposure prior to and after onset measured by annual questionnaire; ultraviolet radiation (UVR) “load” estimated by location of residence over the life course and ambient UVR levels. Serum 25-hydroxyvitamin D [25(OH)D] concentrations measured at baseline, 2/3-year, and 5-year review. MS conversion and relapse assessed by neurologist assessment and medical record review.ResultsOver two-thirds (69%) of those followed to 5-year review (100/145) converted to MS, with a total of 252 relapses. Higher pre-MS onset sun exposure was associated with reduced risk of MS conversion, with internal consistency between measures and dose–response relationships. Analogous associations were also seen with risk of relapse, albeit less strong. No consistent associations were observed between postonset sun exposure and clinical course, however. Notably, those who increased their sun exposure during follow-up had significantly reduced hazards of MS conversion and relapse. Serum 25(OH)D levels and vitamin D supplementation were not associated with conversion to MS or relapse hazard.ConclusionWe found that preonset sun exposure was protective against subsequent conversion to MS and relapses. While consistent associations between postonset sun exposure or serum 25(OH)D level and clinical course were not evident, possibly masked by behavior change, those participants who markedly increased their sun exposure demonstrated a reduced MS conversion and relapse hazard, suggesting beneficial effects of sun exposure on clinical course.

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Section: Discussioncontrasting

confidence: 99%

Sun Exposure across the Life Course Significantly Modulates Early Multiple Sclerosis Clinical Course

et al. 2018

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“…We collected data of patients treated at European MS centers located in Athens (Greece), Bern (Switzerland), Bochum (Germany), and Peine (Germany). In the participating centers, data were gathered from medical records and from previously published retrospective MS studies with different nonepidemiological scopes . The study was approved by the responsible local ethics committees (Eginition Hospital, Athens University Medical School; Bern University Hospital: KEK‐BE 2017‐01369; Ruhr‐University Bochum: 5408‐15; Medical Association of Lower Saxony (06/17/16)).…”

Section: Methodsmentioning

confidence: 99%

Age‐dependent variation of female preponderance across different phenotypes of multiple sclerosis: A retrospective cross‐sectional study

et al. 2018

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Summary Introduction Multiple sclerosis (MS) is an autoimmune disease of the CNS, which predominantly affects women. Studies investigating the sex distribution in MS are sparse. We aim to analyze the female‐to‐male ratio (F/M ratio) in different MS phenotypes in association with age at diagnosis and year of birth. Methods We performed a retrospective cross‐sectional analysis by cumulating data (sex, year of birth, age at diagnosis, and MS phenotypes) from unpublished and published studies of the participating centers. Results Datasets of 945 patients were collected. The overall F/M ratio was 1.9:1.0 and female preponderance was present in all phenotypes except for primary progressive MS (PPMS), in which men were predominantly affected (F/M ratio: 0.5:1.0). Female preponderance declined with increasing age at diagnosis and was no longer present in relapsing‐remitting MS (RRMS) patients > 58 years of age. Conclusion Our data demonstrate an age dependency of female preponderance in MS except for PPMS. This could be influenced by the lifecycle of sex hormone secretion in women. In PPMS, a male preponderance was observed in all age‐groups, which might point to pathophysiological mechanisms being less influenced by sex hormones.

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“…Since in both studies, SOLAR and CHOLINE, cholecalciferol was used as an add-on to interferon-beta, it is important to mention that in patients being treated with interferon-beta who received repeated MRI scans and measurements of serum 25(OH)D concentration, an inverse correlation between 25(OH)D and MRI activity was found before but not during treatment with interferon-beta (126). Other vitamin D supplementation studies investigating relapse risk, CNS lesions, and/or disability progression were either substantially smaller, or of shorter duration, or were not prospectively randomized and are therefore only listed in the reference section [see (127)(128)(129)(130)]. Regarding the effects of vitamin D supplementation on fatigue and depression scores, Rolf et al showed in a prospectively studied cohort of 40 MS patients that patients receiving cholecalciferol for 48 weeks did not improve significantly in fatigue or depression scores in comparison to placebo (131).…”

Section: Vitamin D Supplementation and Its Association With Ms Risk Amentioning

confidence: 99%

A Brief Review of the Effects of Vitamin D on Multiple Sclerosis

et al. 2020

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Multiple sclerosis (MS) is characterized as an autoimmune disease affecting the central nervous system. It is one of the most common neurological disorders in young adults. Over the past decades, increasing evidence suggested that hypovitaminosis D is a contributing factor to the risk of developing MS. From different risk factors contributing to the development of MS, vitamin D status is of particular interest since it is not only a modifiable risk factor but is also associated with MS disease activity. MS patients with lower serum vitamin D concentrations were shown to have higher disease activity. However, this finding does not demonstrate causality. In this regard, prospective vitamin D supplementation studies missed statistical significance in its primary endpoints but showed promising results in secondary outcome measures or post hoc analyses. An explanation for missed primary endpoints may be underpowered trials. Besides vitamin D supplementation as a potential add-on to long-term immunotherapeutic treatment, a recent laboratory study of our group pointed toward a beneficial effect of vitamin D to improve the efficacy of glucocorticoids in relapse therapy. In the following article, we will briefly review the effects of vitamin D on MS by outlining its effects on the immune and nervous system and by reviewing the association between vitamin D and MS risk as well as MS disease activity. We will also review the effects of vitamin D supplementation on MS risk and MS disease activity.

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Vitamin D supplementation differentially affects seasonal multiple sclerosis disease activity

Cited by 24 publications

References 25 publications

Sun Exposure across the Life Course Significantly Modulates Early Multiple Sclerosis Clinical Course

Sun Exposure across the Life Course Significantly Modulates Early Multiple Sclerosis Clinical Course

Age‐dependent variation of female preponderance across different phenotypes of multiple sclerosis: A retrospective cross‐sectional study

A Brief Review of the Effects of Vitamin D on Multiple Sclerosis

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