High-dose vitamin D therapy successful for patients with cystic fibrosis

Vitamin D levels in patients with a deficiency and cystic fibrosis increased with a single high dose, or stoss therapy, according to a poster presented at the North American Cystic Fibrosis Conference.

“Vitamin D deficiency can lead to poor bone health (osteomalacia) and has been associated with worsening lung disease in [persons with cystic fibrosis],” Jillian S. Sullivan, MD, MSCS, professor of pediatrics at the Larner College of Medicine at The University of Vermont, and colleagues wrote. “Despite this knowledge and prescription of daily vitamin D supplementation for [persons with cystic fibrosis], vitamin D deficiency has remained common in our adult and pediatric cystic fibrosis clinics.”

In a quality improvement initiative, Sullivan and colleagues assessed 56 patients with a vitamin D level less than 30 ng/mL to observe if integrating stoss, a high-dose vitamin D therapy of 500,000 IU, into routine clinical care helped them reach a vitamin D level greater than or equal to 30 ng/mL, according to the study abstract.

Patients included were aged 5 years and older from the University of Vermont Medical Center’s pediatric and adult cystic fibrosis clinics and attended the clinic either in-person or by telemedicine.

In order to incorporate stoss therapy into the clinic’s routine and measure quality improvement, researchers used a swim lane diagram and plan-do-study-act cycles. They also measured vitamin D levels at baseline and gave patients a high-fat snack to take with their stoss dose.

Of the 56 patients, 35 (62%) had a vitamin D level of 20 ng/mL to 29 ng/mL, and 21 (38%) had a level less than 20 ng/mL at baseline, with an overall range of 5 ng/mL to 29.8 ng/mL, according to researchers.

Researchers gave 45 patients stoss dosing, and 37 patients had a repeat vitamin D level taken after a mean of 115 days (range, 45-238 days).

Of them, 17 (46%) achieved a vitamin D level of 30 ng/mL or higher, whereas seven (19%) had a vitamin D level of 20 ng/mL or less after one dose of stoss therapy, with an overall range of 6 ng/mL to 51 ng/mL, according to the abstract.

“Stoss vitamin D dosing can be successfully implemented in routine cystic fibrosis care and increases vitamin D levels in [persons with cystic fibrosis] and vitamin D deficiency,” Sullivan and colleagues wrote.