期刊
NEUROLOGY
卷 77, 期 17, 页码 1611-1618出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/WNL.0b013e3182343274
关键词
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资金
- Myer Foundation
- Multiple Sclerosis International Federation
- National Science Foundation of China [81101038]
- Merck Serono
- Biogen Idec
- Bayer Schering Pharma
- Sanofi-Aventis
- Multiple Sclerosis Research Australia
- National MS Society (USA)
- National Health Medical Research Council Australia
- ANZ Trustees, Melbourne, Australia
- Australian Research Council
- Australian Government Department of Industry, Innovation, Science and Research
- National Multiple Sclerosis Society (USA)
- Cure Huntington's Disease initiative (CHDI)
- Boston Scientific
- Talecris Biotherapeutics
- Juvenile Diabetes Research Foundation
- Novartis
- National Health and Medical Research Council (NHMRC)
- MS Society (USA)
- MS Research Australia
Objective: Higher latitude, lower ultraviolet exposure, and lower serum 25-hydroxyvitamin D (25OHD) correlate with higher multiple sclerosis (MS) prevalence, relapse rate, and mortality. We therefore evaluated the effects of high-dose vitamin D2 (D2) in MS. Methods: Adults with clinically active relapsing-remitting MS (RRMS) were randomized to 6 months' double-blind placebo-controlled high-dose vitamin D2, 6,000 IU capsules, dose adjusted empirically aiming for a serum 25OHD 130-175 nM. All received daily low-dose (1,000 IU) D2 to prevent deficiency. Brain MRIs were performed at baseline, 4, 5, and 6 months. Primary endpoints were the cumulative number of new gadolinium-enhancing lesions and change in the total volume of T2 lesions. Secondary endpoints were Expanded Disability Status Scale (EDSS) score and relapses. Results: Twenty-three people were randomized, of whom 19 were on established interferon or glatiramer acetate (Copaxone) treatment. Median 25OHD rose from 54 to 69 nM (low-dose D2) vs 59 to 120 nM (high-dose D2) (p = 0.002). No significant treatment differences were detected in the primary MRI endpoints. Exit EDSS, after adjustment for entry EDSS, was higher following high-dose D2 than following low-dose D2 (p = 0.05). There were 4 relapses with high-dose D2 vs none with low-dose D2 (p = 0.04). Conclusion: We did not find a therapeutic advantage in RRMS for high-dose D2 over low-dose D2 supplementation. Classification of evidence: This study provides Class I evidence that high-dose vitamin D2 (targeting 25OHD 130-175 nM), compared to low-dose supplementation (1,000 IU/d), was not effective in reducing MRI lesions in patients with RRMS. Neurology (R) 2011;77:1611-1618
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