MS progression strongly predicted by low vitamin D levels

For patients in the early stages of multiple sclerosis (MS), low levels of vitamin D were found to strongly predict disease severity and hasten its progression, according to a study online January 20, 2014 in JAMA Neurology.

The findings suggest that patients in the early stages of MS could stave off disease symptoms by increasing their vitamin D intake, according to researchers from the Harvard School of Public Health (HSPH) in collaboration with Bayer HealthCare.

The World Health Organization estimates that approximately 2.5 million people in the world have MS.

“Adequate vitamin D levels in the early stages of MS were associated with a reduced rate of new active lesions, lower relapse rate, and lower annual increase in T2 lesion volume,” said coauthor Kassandra Munger, HSPH research associate in the HSPH Department of Nutrition.

The study

Researchers analyzed data from 465 MS patients from 18 European countries, Israel, and Canada who enrolled in 2002 and 2003 in the BENEFIT (Betaferon/Betaseron in Newly Emerging multiple sclerosis For Initial Treatment) trial, which was aimed at comparing the effectiveness of early versus late interferon beta-1b in treating the disease. The scientists looked at how the patients’ vitamin D levels-which were measured at the onset of their symptoms and at regular intervals over a 24-month period-correlated with their disease symptoms and progression over a period of 5 years.

The researchers measured 25-hydroxyvitamin D in blood samples collected at baseline, 6 months, 12 months, and 24 months.  MRIs were also done and relapses recorded over the course of the clinical trial.  Using statistical methods for prospective, longitudinal analysis, they looked for an association between 25-hydroxyvitamin D levels in the first 12 months of the trial and outcomes between 12 and 60 months.  

Findings

They found that early-stage MS patients who had adequate levels of vitamin D had a 57% lower rate of new brain lesions, a 57% lower relapse rate, and a 25% lower yearly increase in lesion volume than those with lower levels of vitamin D. Loss in brain volume, which is an important predictor of disability, was also lower among patients with adequate vitamin D levels. The results suggest that vitamin D has a strong protective effect on the disease process underlying MS, and underscore the importance of correcting vitamin D insufficiency, which is widespread in Europe and the United States.

“Previous studies have suggested that high 25-hydroxyvitamin D levels are associated with a decreased risk of MS onset, and other clinical studies have suggested high 25-hydroxyvitamin D may be associated with favorable outcomes such as reduced lesions and relapse rates, however, these studies have either been cross-sectional-thus cannot determine if the low vitamin D levels were a possible cause or consequence of the disease process-or follow-up time was shorter than in our study,” Munger said. 

“Our study suggests that adequate vitamin D has an important role in the early treatment of MS and patients should be screened for vitamin D deficiency and supplemented with vitamin D to bring blood levels over 50 nmol/L,” she said.