CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Vitamin D as an early predictor of multiple sclerosis activity and progression
Multiple sclerosis is a common cause of neurological disability in young adults, but the etiology of the disease is unknown. Most patients have episodes of inflammatory demyelination followed by treatment-resistant disease progression and brain atrophy. A higher risk of multiple sclerosis (MS) in individuals with low vitamin D intake or low circulating 25-hydroxyvitamin D 25(OH)D has been reported. Therefore, supplementation with vitamin D could potentially benefit a large proportion of patients with MS. The authors conducted a study to determine if vitamin D levels early in the disease process influenced long-term disease outcomes in subjects who were already participating in the Betaferon/Betaseron in Newly Emerging Multiple Sclerosis for Initial Treatment (BENEFIT) trial. The authors studied 465 patients who had at least one 25(OH)D measurement. The majority of patients had measurements at baseline and six and 12 months. These patients were then followed up clinically for five years and by magnetic resonance imaging. Three outcome categories were analyzed using clinical and MRI testing: time to definite diagnosis of MS, MS activity, and MS progression. Of interest, higher 25(OH)D levels predicted reduced MS activity and a lower rate of disease progression. Furthermore, patients with serum 25(OH)D concentrations of 50 nmol/L or more had a four times lower change in T2 lesion volume, a twofold lower rate of brain atrophy, and lower disability compared to those with lower vitamin D concentrations. The authors concluded that results from this large longitudinal study showed that higher serum 25(OH)D levels predicted lower degrees of MS activity, MRI lesion load, brain atrophy, and clinical progression during the five years of follow-up. This suggests that identifying and correcting vitamin D insufficiency may be important in the early treatment of MS.
Ascherio A, Munger KL, White R, et al. Vitamin D as an early predictor of multiple sclerosis activity and progression. JAMA Neurol. 2014;71(3):306–314.
Correspondence: Dr. Alberto Ascherio at aascheri@hsph.harvard.edu