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Vitamin D Status Increases Odds of Remission in Patients with Inflammatory Bowel Disease

6/20/2017 2:06:24 PM
Vitamin D deficiency has been reported in nearly 50% of patients with inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease. Vitamin D deficiency is associated with IBD severity and complications, leading researchers to suspect that vitamin D may influence the clinical course of IBD.
 
The primary mechanism by which vitamin D is thought to influence IBD is immune modulation. Vitamin D induces T regulatory cells, effectively increasing the production of anti-inflammatory cytokines and decreasing production of pro-inflammatory cytokines. Vitamin D in the form of 1,25(OH)2D3 down-regulates numerous genes associated with TNF-α, suggesting that it may work synergistically with the commonly prescribed anti-TNF-α medications to decrease inflammation.
 
In a retrospective study, published by Winter et al in 2017, researchers evaluated the relationship between vitamin D levels and odds of reaching remission on an anti-TNF-α medication. A total of 173 adults with IBD were included in the analysis. Serum 25OHD3 concentrations were measured within 6 months before or 2 weeks after initiating anti-TNF-α medication. The primary outcome measure was remission at 3 months.
 
After controlling for age, gender, diagnosis, and type of anti-TNF-α medication, patients with normal vitamin D levels at the time of initiating medication had significantly greater odds of remission at 3 months than patients with low vitamin D levels (odds ratio for remission = 2.64; 95% CI, 1.31-5.32; p=.0067). Because patient data included results from multiple laboratories, the lower cutoff for normal vitamin D levels ranged from 9 to 33ng/mL.
 
The authors conclude that vitamin D levels may influence the initial response to anti-TNF-α medications and that vitamin D deficiency may decrease the odds of remission in patients with IBD.
 
Reference: Winter RW, Collins E, Cao B, Carrellas M, Crowell AM, Korzenik JR. Higher 25-hydroxyvitamin D levels are associated with greater odds of remission with anti-tumour necrosis factor-α medications among patients with inflammatory bowel diseases. Aliment Pharmacol Ther. 2017;45(5):653-659.