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Vitamin D status and effect of low-dose cholecalciferol and high-dose ergocalciferol supplementation in multiple sclerosis

Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA

D Cettomai

Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA

M Baynes

Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA

JN Ratchford

Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA

S Newsome

Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA

D Harrison

Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA

D Kerr

Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA

BM Greenberg

Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA

PA Calabresi

Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USAcalabresi{at}jhmi.edu

Background

Vitamin D is important for bone health and immune regulation, and has been shown to be low in multiple sclerosis (MS). We sought to determine the effect of over the counter low dose cholecalciferol (LDC) and high dose ergocalciferol (HDE) on the vitamin D levels in MS patients.

Methods

We retrospectively evaluated serum 25-hydroxy-vitamin D [25(OH)D] levels of 199 patients (CIS, n = 32; RRMS, n = 115; PPMS, n = 10; SPMS, n = 16; Transverse Myelitis (TM), n = 9; other neurological diseases, n = 16) attending our clinic between 2004 and 2008. We examined the change in 25(OH)D levels in 40 MS patients who took either LDC (800 IU/day) or HDE (50,000 IU/day for 7-10 days, followed by 50,000 IU weekly or biweekly).

Results

The average 25(OH)D level was 71 ± 39 nmol/L (Mean ± SD), and 167(84%) patients had insufficient levels (100 nmol/L) of 25(OH)D. The patients supplemented with LDC did not have a significant increase in their 25(OH)D levels. However, 25(OH)D levels increased by 42 nmol/L (P = 0.01) in the patients originally taking LDC and then prescribed HDE. Optimal levels (100 nmol/L) were only achieved in less than 40% of patients.

Conclusions

We conclude that large numbers of patients with MS and TM in our cohort are deficient in vitamin D. HDE significantly elevated 25(OH)D levels in MS patients and was more effective at increasing 25(OH)D levels than LDC. Prospective studies are required to determine appropriate dosing regimen to achieve optimal levels in the majority of MS patients and to ascertain the safety, immunological response, and ultimately the clinical efficacy of vitamin D replacement therapy.

Key Words: 25-hydroxy vitamin D • cholecalciferol • demyelinating diseases • ergocalciferol • MS • vitamin D deficiency

This version was published on June 1, 2009

Multiple Sclerosis, Vol. 15, No. 6, 735-740 (2009)
DOI: 10.1177/1352458509102844


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