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High-dose vitamin D failed to increase recovery rate in patients with TB
Martineau A. Lancet. doi:10.1016/S0140-6736(10)61889-2.
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Although the use of high-dose vitamin D supplementation did not increase recovery time in patients with tuberculosis, it did increase the recovery rate by 1 week in a subset of patients with one variation of the vitamin D receptor, according to new study findings from the UK.
“Vitamin D significantly hastens sputum culture conversion in patients who have the tt genotype of the Taql polymorphism of the vitamin D receptor, but does not have this effect in patients with TT or Tt genotypes,” Adrian R. Martineau, MD, of Queen Mary University of London, told Infectious Disease News.
For the randomized, controlled trial, Martineau and colleagues assessed the effect of high-dose vitamin D in adults with sputum smear positive pulmonary TB. Patients (n=146) were randomly assigned to either four doses of 2.5 mg vitamin D (n=62) or placebo (n=64) at baseline and again at 14, 28, and 42 days after initiation of TB treatment.
Median time from initiation of antimicrobial treatment to sputum culture conversion was 36 days for the intervention group and 43.5 days for the placebo group (95% CI, 0.90–2.16).
According to the researchers, the effect of vitamin D was modified by TaqI genotype and an enhanced response was observed in those with the tt genotype (95% CI, 1.36-48.01). However, FoKI genotype did not alter the effect of vitamin D (P=0.85).
Compared with a mean serum 25-hydroxyvitamin D concentration of 101.4 nmol/L at 56 days for those in the intervention group, mean serum concentration was only 22.8 nmol/L in the placebo group (95% CI, 68.6-88.2).
“If physicians are able to determine their patients’ vitamin D receptor genotype, then they could offer vitamin D supplementation to those with the tt genotype of the TaqI vitamin D receptor polymorphism,” Martineau said. “Where such testing is unavailable, clinicians may feel that the potential benefits of vitamin D supplementation outweigh the risks — in the study population as a whole, patients receiving vitamin D cleared mycobacteria from their sputum 1 week more quickly than those receiving standard treatment alone.”
In an accompanying editorial, Reinhold Vieth, PhD, of the department of laboratory medicine and pathobiology at the University of Toronto, wrote that, “Martineau and colleagues showed that the addition of vitamin D shortened the time to sputum clearance by 1 week, from 43.5 to 36 days, but the decrease did not reach conventional statistical significance. For patients possessing the tt genotype of the TaqI vitamin D receptor polymorphism, vitamin D produced a remarkable acceleration in clearance of mycobacilli from sputum. For the other subgroups with active disease in all the trials, the conclusion must await a future meta-analysis. However, no one is addressing whether activation of latent TB might have been prevented if vitamin D nutritional status had not been so low in these patients.” - by Ashley DeNyse
Disclosures: Dr. Martineau reports no relevant disclosures.
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