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MS research update – Could vitamin D make disease modifying drugs more effective against MS? – 24 November 2015

Summary

Vitamin D and the disease modifying drugs (DMDs) both have effects on the immune system. This study investigated to see if vitamin D levels could help to reduce MS disease activity further in people also taking one of the beta interferons, glatiramer acetate or fingolimod.

In participants taking beta interferon or fingolimod, those with higher blood levels of vitamin D had less new inflammatory events such as relapses and active brain lesions. This effect was not seen in participants taking glatiramer acetate.

The study raises the possibility that vitamin D may make certain DMDs more effective against MS damage. However the study did raise more questions than it answered and further studies would be needed to explore what exactly was going on and what it is about vitamin D that appears to be causing the effect observed.

Background

Vitamin D has several important roles in the body including regulating immune responses. There is some evidence that lower levels of vitamin D are associated with higher relapse rates and greater disability.

The disease modifying drugs (DMDs) are a group of treatments for people with relapsing remitting MS. They work with different parts of the immune system to reduce the inflammation caused by MS to nerve cells in the brain and spinal cord, so this helps reduce the number and severity of relapses. 

As both vitamin D and DMDs work on the immune system this study investigated to see if vitamin D levels could help to reduce MS disease activity further in people also taking a DMD.

How this study was carried out

The Comprehensive Longitudinal Investigation of MS at the Brigham and Women’s Hospital (CLIMB) study is a long term study of MS in the USA. All participants in this study have a clinic visit every six months where they have a full assessment and they have an MRI scan every 12 months.

324 people with relapsing remitting MS who are enrolled in CLIMB took part in this study. 96 were taking one of the beta interferons (Avonex, Betaferon or Rebif), 151 were taking glatiramer acetate (Copaxone) and 77 were taking fingolimod (Gilenya).

Blood samples were taken to measure levels of vitamin D. As participants’ blood samples were taken at different times of the year, these measurements were adjusted for seasonal variations in sunlight using a standard model.

The researchers looked at which DMD a participant was taking, their vitamin D levels and compared this information with data collected about relapses, lesions seen on MRI scans and disability progression.  

What was found

In participants taking beta interferon or fingolimod, those with higher blood levels of vitamin D had less new inflammatory events such as relapses and active brain lesions. This effect was not seen in participants taking glatiramer acetate.

There were also no significant changes in disability progression observed regardless of which DMD participants were taking or what their vitamin D levels were.

What does it mean?

The study raises the possibility that vitamin D may make certain DMDs more effective against MS damage. However the study did raise more questions than it answered. The results were mixed, for example no effect was seen for glatiramer acetate. This may be because the effect was smaller or more difficult to detect than for the other drugs in this study, or the effect on the immune system was very similar between the drug and vitamin D, whereas for the other drugs it was working in different ways so it was complementary. Additionally this study did not look at all available DMDs and as they each work in a slightly different way, the effect of higher vitamin D levels may be different.

The researchers concluded that vitamin D supplementation could be a low-cost and low-risk add on to DMD treatment, however there is not sufficient evidence from this small study alone to confirm that it would be an effective treatment. Further larger studies, would be needed to explore the effect of vitamin D with the different DMDs and also look into the specific effects on the immune system.

Rotstein DL, Healy BC, Malik MT, et al.
Effect of vitamin D on MS activity by disease-modifying therapy class.
Neurol Neuroimmunol Neuroinflamm. 2015 Oct 29;2(6):e167. eCollection 2015.
Abstract
Read the full text of this paper

More about vitamin D

Vitamin D has several important roles in the body including keeping bones and teeth strong and healthy and regulating immune responses. It can be obtained in several ways. It is manufactured by the skin when it is exposed to sunlight, it can be obtained in the diet by eating food such as oily fish (including salmon and sardines) or fortified foods such as fat spreads and breakfast cereals or by taking supplements.

Its possible role in multiple sclerosis is the focus of much debate and research. It is known that multiple sclerosis is more common in countries further from the equator. As vitamin D is made in the skin, this has led to the hypothesis that low sunlight exposure and consequent low vitamin D production triggers the development of MS. There is some evidence that lower levels of vitamin D are associated with higher relapse rates and greater disability. Studies are underway to investigate both the role of vitamin D as a protective agent against the development of MS and as a treatment for people with the condition.

You can also read more about Vitamin D in the A to Z of MS.

Research by topic areas...

Assessment tools

Chua AS, Glanz BI, Guarino AJ, et al.
Patient-reported outcomes in multiple sclerosis: relationships among existing scales and the development of a brief measure.
Mult Scler Relat Disord. 2015 Nov;4(6):598-606.
Abstract

O'Connell K, Langdon D, Tubridy N, et al.
A preliminary validation of the brief international cognitive assessment for multiple sclerosis (BICAMS) tool in an Irish population with multiple sclerosis (MS).
Mult Scler Relat Disord. 2015 Nov;4(6):521-525.
Abstract

Fritz NE, Jiang A, Keller J, et al.
The utility of the six-spot step test as a measure of walking performance in ambulatory individuals with multiple sclerosis across the disability spectrum.
Arch Phys Med Rehabil. 2015 Nov 11. [Epub ahead of print]
Abstract

Causes of MS

Xia Z, White CC, Owen EK, et al.
GEMS project: a platform to investigate multiple sclerosis risk.
Ann Neurol. 2015 Nov 19. [Epub ahead of print]
<a data-cke-saved-href="http://www.ncbi.nlm.nih.gov/pubmed/26583565" href="//www.mstrust.org.uk/%3Ca%20href%3D"http://www.ncbi.nlm.nih.gov/pubmed/26583565">http://www.ncbi.nlm.nih.gov/pubmed/26583565" "="" title="Opens in new tab">Abstract

Co-existing conditions

Capkun G, Dahlke F, Lahoz R, et al.
Mortality and comorbidities in patients with multiple sclerosis compared with a population without multiple sclerosis: An observational study using the US Department of Defense administrative claims database.
Mult Scler Relat Disord. 2015 Nov;4(6):546-554.
Abstract
Read the full text of this paper

Pathophysiology

Guzel I, Mungan S, Oztekin ZN, et al.
Is there an association between the expanded disability status scale and inflammatory markers in multiple sclerosis?
J Chin Med Assoc. 2015 Nov 14. [Epub ahead of print]
Abstract
Read the full text of this paper

Kappos L, De Stefano N, Freedman MS, et al.
Inclusion of brain volume loss in a revised measure of 'no evidence of disease activity' (NEDA-4) in relapsing-remitting multiple sclerosis.
Mult Scler. 2015 Nov 19. [Epub ahead of print]
Abstract

Cawley N, Solanky BS, Muhlert N, et al.
Reduced gamma-aminobutyric acid concentration is associated with physical disability in progressive multiple sclerosis.
Brain. 2015 Sep;138(Pt 9):2584-95.
Abstract

Physical activity

Galli M, Coghe G, Sanna P, et al.
Relationship between gait initiation and disability in individuals affected by multiple sclerosis.
Mult Scler Relat Disord. 2015 Nov;4(6):594-597.
Abstract

Fry DK, Huang MH, Rodda BJ.
Predictors of static balance in ambulatory persons with multiple sclerosis.
Int J Rehabil Res. 2015 Nov 17. [Epub ahead of print]
Abstract

Hausmann J, Sweeney-Reed CM, Sobieray U, et al.
Functional electrical stimulation through direct 4-channel nerve stimulation to improve gait in multiple sclerosis: a feasibility study.
J Neuroeng Rehabil. 2015 Nov 14;12(1):100.
Abstract
Read the full text of this paper

Sandroff BM, Hillman CH, Benedict RH, et al.
Acute effects of varying intensities of treadmill walking exercise on inhibitory control in persons with multiple sclerosis: a pilot investigation.
Physiol Behav. 2015 Nov 10. [Epub ahead of print]
Abstract

Quality of life

Van Damme S, De Waegeneer A, Debruyne J.
Do flexible goal adjustment and acceptance help preserve quality of life in patients with multiple sclerosis?
Int J Behav Med. 2015 Nov 20. [Epub ahead of print]
Abstract

Rehabilitation

Pau M, Coghe G, Corona F, et al.
Effectiveness and limitations of unsupervised home-based balance rehabilitation with Nintendo Wii in people with multiple sclerosis.
Biomed Res Int. 2015;2015:916478. Epub 2015 Oct 25.
Abstract
Read the full text of this paper

Symptoms and symptom management

Nygaard GO, de Rodez Benavent SA, Harbo HF, et al.
Eye and hand motor interactions with the symbol digit modalities test in early multiple sclerosis.
Mult Scler Relat Disord. 2015 Nov;4(6):585-589.
Abstract
Read the full text of this paper

Dulamea AO, Boscaiu V, Sava MM.
Disability status and dental pathology in multiple sclerosis patients.
Mult Scler Relat Disord. 2015 Nov;4(6):567-571.
Abstract

Scheepe JR, Wong YY, van Pelt ED, et al.
Neurogenic lower urinary tract dysfunction in the early disease phase of paediatric multiple sclerosis.
Mult Scler. 2015 Nov 20. [Epub ahead of print]
Abstract

Dagenais E, Rouleau I, Tremblay A, et al.
Role of executive functions in prospective memory in multiple sclerosis: Impact of the strength of cue-action association.
J Clin Exp Neuropsychol. 2015 Nov 20:1-14. [Epub ahead of print]
Abstract

Rommer PS, Kamin F, Abu-Mugheisib M, et al.
Long-term effects of repeated cycles of intrathecal triamcinolone acetonide on spasticity in MS patients.
CNS Neurosci Ther. 2015 Nov 20. [Epub ahead of print]
Abstract

Nazari F, Soheili M, Hosseini S, et al.
A comparison of the effects of reflexology and relaxation on pain in women with multiple sclerosis.
J Complement Integr Med. 2015 Nov 18. [Epub ahead of print]
Abstract

Nikseresht A, Salehi H, Foroughi AA, et al.
Association between urinary symptoms and urinary tract infection in patients with multiple sclerosis.
Glob J Health Sci. 2015 Sep 28;8(4):48574.
Abstract
Read the full text of this paper (PDF)

Morrow SA, Rosehart H, Pantazopoulos K.
Anxiety and depressive symptoms are associated with worse performance on objective cognitive tests in MS.
J Neuropsychiatry Clin Neurosci. 2015 Nov 16:appineuropsych15070167. [Epub ahead of print]
Abstract

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