JagannadhaAvasarala, Associate Professor of Neurology, Greenville Health Systemjavasarala@ghs.org
Submitted February 04, 2016
The recent study by Sotirchos et al. [1] provided Class I evidence that cholecalciferol (vitamin D3) supplementation with 10,400 IU daily is safe and well tolerated in patients with multiple sclerosis (MS) and exhibits in vivo pleiotropic immunomodulatory effects. This is welcome news for patients with MS and for clinicians who ponder over what effects cholecalciferol has on interleukins, T cells, and the course of the disease.
Since this is a pilot study, some key cautionary observations are in order as it applies to the African-American cohort of patients. This study included only 4 African-American patients, a paltry number at best, and no conclusions can be drawn with such small numbers. The effect of 25-hydroxyvitamin D supplementation in African Americans was not observed and pre-morbid levels of vitamin D did not have any bearing on MS risk in this cohort. [2,3] The reasons for this disparity between Caucasians and African Americans with MS remains poorly researched, but could possibly be related to bio-availability of 25-hydroxyvitamin D that, in turn, is linked to polymorphism in the vitamin D-binding protein gene. [4] Hence, not all races may be similar. Also, African Americans may erroneously be diagnosed as having vitamin D deficiency based on serum levels alone. [4] This, too, must be evaluated further or physicians may be needlessly treating patients who never needed supplementation.
1. Sotirchos ES, Bhargava P, Eckstein C, et al. Safety and immunologic effects of high- vs low-dose cholecalciferol in multiple sclerosis. Neurology 2016;86:382-290.
2. Avasarala J, Zachariah P. Vitamin D deficiency in multiple sclerosis: Should testing and treatment be based on racial background? J Neurol Sci 2015;358:417-418.
3. Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA 2006;296:2832-2838.
4. Powe CE, Evans MK, Wenger J, et al. Vitamin-D binding protein and vitamin D status of black Americans and white Americans. N Engl J Med 2013;369:1991-2000.
For disclosures, please contact the editorial office at journal@neurology.org.
The recent study by Sotirchos et al. [1] provided Class I evidence that cholecalciferol (vitamin D3) supplementation with 10,400 IU daily is safe and well tolerated in patients with multiple sclerosis (MS) and exhibits in vivo pleiotropic immunomodulatory effects. This is welcome news for patients with MS and for clinicians who ponder over what effects cholecalciferol has on interleukins, T cells, and the course of the disease.
Since this is a pilot study, some key cautionary observations are in order as it applies to the African-American cohort of patients. This study included only 4 African-American patients, a paltry number at best, and no conclusions can be drawn with such small numbers. The effect of 25-hydroxyvitamin D supplementation in African Americans was not observed and pre-morbid levels of vitamin D did not have any bearing on MS risk in this cohort. [2,3] The reasons for this disparity between Caucasians and African Americans with MS remains poorly researched, but could possibly be related to bio-availability of 25-hydroxyvitamin D that, in turn, is linked to polymorphism in the vitamin D-binding protein gene. [4] Hence, not all races may be similar. Also, African Americans may erroneously be diagnosed as having vitamin D deficiency based on serum levels alone. [4] This, too, must be evaluated further or physicians may be needlessly treating patients who never needed supplementation.
1. Sotirchos ES, Bhargava P, Eckstein C, et al. Safety and immunologic effects of high- vs low-dose cholecalciferol in multiple sclerosis. Neurology 2016;86:382-290.
2. Avasarala J, Zachariah P. Vitamin D deficiency in multiple sclerosis: Should testing and treatment be based on racial background? J Neurol Sci 2015;358:417-418.
3. Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA 2006;296:2832-2838.
4. Powe CE, Evans MK, Wenger J, et al. Vitamin-D binding protein and vitamin D status of black Americans and white Americans. N Engl J Med 2013;369:1991-2000.
For disclosures, please contact the editorial office at journal@neurology.org.